Beruflich Dokumente
Kultur Dokumente
Drinking-water Quality
FOURTH EDITION
Contents
Preface
Acknowledgements
Acronyms and abbreviations used in text
1.
xv
xvii
xx
Introduction
1.1 General considerations and principles
1.1.1 Framework for safe drinking-water
1.1.2 Microbial aspects
1.1.3 Disinfection
1.1.4 Chemical aspects
1.1.5 Radiological aspects
1.1.6 Acceptability aspects: taste, odour and appearance
1.2 Roles and responsibilities in drinking-water safety management
1.2.1 Surveillance and quality control
1.2.2 Public health authorities
1.2.3 Local authorities
1.2.4 Water resource management
1.2.5 Drinking-water supply agencies
1.2.6 Community management
1.2.7 Water vendors
1.2.8 Individual consumers
1.2.9 Certification agencies
1.2.10 Plumbing
1.3 Supporting resources to the Guidelines
1.3.1 Published documents
1.3.2 Capacity-building networks
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2.3
2.4
2.5
2.6
2.7
Surveillance
Verification of drinking-water quality
2.4.1 Microbial water quality
2.4.2 Chemical water quality
Identifying priority concerns
2.5.1 Undertaking a drinking-water quality assessment
2.5.2 Assessing microbial priorities
2.5.3 Assessing chemical priorities
Developing drinking-water quality standards
2.6.1 Adapting guideline values to locally relevant standards
2.6.2 Periodic review and revision of standards
Drinking-water regulations and supporting policies and programmes
2.7.1 Regulations
2.7.2 Supporting policies and programmes
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3. Health-based targets
3.1 Setting health-based targets
3.2 Disability-adjusted life years, tolerable disease burden and
reference level of risk
3.3 Types of health-based targets
3.3.1 Health outcome targets
3.3.2 Water quality targets
3.3.3 Performance targets
3.3.4 Specified technology targets
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4.
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CONTENTS
4.4
4.5
4.6
4.7
5. Surveillance
5.1 Types of approaches
5.1.1 Audit
5.1.2 Direct assessment
5.2 Adapting approaches to specific circumstances
5.2.1 Urban areas in developing countries
5.2.2 Surveillance of community drinking-water supplies
5.2.3 Surveillance of household treatment and storage systems
5.3 Adequacy of supply
5.3.1 Quantity (service level)
5.3.2 Accessibility
5.3.3 Affordability
5.3.4 Continuity
5.4 Planning and implementation
5.5 Reporting and communicating
5.5.1 Interaction with community and consumers
5.5.2 Regional use of data
6. Application of the Guidelines in specific circumstances
6.1 Climate change, water scarcity and heavy rainfall
6.2 Rainwater harvesting
6.3 Vended water
6.4 Bulk water supply
6.5 Desalination systems
6.6 Dual piped water supply systems
6.7 Emergencies and disasters
6.8 Temporary water supplies
6.9 Buildings
6.10 Health-care facilities
6.11 Safe drinking-water for travellers
6.12 Aircraft and airports
6.13 Ships
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112
7.
8.
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Microbial aspects
7.1 Microbial hazards associated with drinking-water
7.1.1 Waterborne infections
7.1.2 Emerging issues
7.1.3 Persistence and growth in water
7.1.4 Public health aspects
7.2 Health-based target setting
7.2.1 Health-based targets applied to microbial hazards
7.2.2 Reference pathogens
7.2.3 Quantitative microbial risk assessment
7.2.4 Risk-based performance target setting
7.2.5 Presenting the outcome of performance target development
7.2.6 Adapting risk-based performance target setting to local
circumstances
7.2.7 Health outcome targets
7.3 Occurrence and treatment of pathogens
7.3.1 Occurrence
7.3.2 Treatment
7.4 Microbial monitoring
7.5 Methods of detection of faecal indicator organisms
7.6 Identifying local actions in response to microbial water quality
problems and emergencies
7.6.1 Boil water advisories
7.6.2 Actions following an incident
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122
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133
Chemical aspects
8.1 Chemical hazards in drinking-water
8.2 Derivation of chemical guideline values
8.2.1 Approaches taken
8.2.2 Threshold chemicals
8.2.3 Non-threshold chemicals
8.2.4 Data quality
8.2.5 Provisional guideline values
8.2.6 Chemicals with effects on acceptability
8.2.7 Chemicals not included in the Guidelines
8.2.8 Mixtures
8.2.9 Adapting guideline values to local circumstances
8.3 Analytical achievability
8.4 Treatment
8.4.1 Treatment performance
8.4.2 Process control measures for disinfection by-products
8.4.3 Treatment for corrosion control
8.4.4 Household treatment
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150
150
151
153
CONTENTS
8.5
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176
177
179
adiological aspects
R
9.1 Sources and health effects of radiation exposure
9.1.1 Radiation exposure through ingestion of drinking-water
9.1.2 Radiation-induced health effects through drinking-water
9.2 Rationale for screening levels and guidance levels
9.3 Monitoring and assessment for dissolved radionuclides
9.3.1 Screening of drinking-water supplies
9.3.2 Strategy for assessing drinking-water if screening levels
are exceeded
9.3.3 Strategy for assessing drinking-water if guidance levels
are exceeded
9.3.4 Sampling frequency
9.4 Guidance levels for radionuclides commonly found in
drinking-water
9.5 Analytical methods
9.5.1 Measuring gross alpha and gross beta activity concentrations
9.5.2 Measuring specific radionuclides
9.6 Remedial measures
9.7 Radon
9.7.1 Radon in air and water
9.7.2 Health risks from radon
9.7.3 Guidance on radon in drinking-water supplies
9.7.4 Measuring radon in drinking-water
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8.6
8.7
9.
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9.8
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viii
CONTENTS
11.2
11.3
11.4
11.5
11.6
Burkholderia pseudomallei
Campylobacter
Enterobacter sakazakii
Escherichia coli pathogenic strains
Helicobacter pylori
Klebsiella
Legionella
Leptospira
Mycobacterium
Pseudomonas aeruginosa
Salmonella
Shigella
Staphylococcus aureus
Tsukamurella
Vibrio
Yersinia
Viral pathogens
Adenoviruses
Astroviruses
Caliciviruses
Enteroviruses
Hepatitis A virus
Hepatitis E virus
Rotaviruses and orthoreoviruses
Protozoan pathogens
Acanthamoeba
Balantidium coli
Blastocystis
Cryptosporidium
Cyclospora cayetanensis
Entamoeba histolytica
Giardia intestinalis
Isospora belli
Microsporidia
Naegleria fowleri
Toxoplasma gondii
Helminth pathogens
Dracunculus medinensis
Fasciola spp.
Free-living nematodes
Schistosoma spp.
Toxic cyanobacteria
Indicator organisms
Total coliform bacteria
Escherichia coli and thermotolerant coliform bacteria
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236
237
239
240
241
242
244
245
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249
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253
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257
258
258
260
261
263
264
265
267
268
269
270
271
273
274
276
277
279
280
282
283
285
285
287
288
290
293
294
294
296
297
298
300
301
303
305
CONTENTS
Cyanazine
342
Cyanide
342
Cyanobacterial toxins: Microcystin-LR
344
Cyanogen chloride
346
2,4-D
347
2,4-DB
348
DDT and metabolites
349
Dialkyltins
350
1,2-Dibromo-3-chloropropane
350
1,2-Dibromoethane
351
Dichloroacetic acid
352
Dichlorobenzenes (1,2-dichlorobenzene, 1,3-dichlorobenzene,
1,4-dichlorobenzene)
353
1,1-Dichloroethane
354
1,2-Dichloroethane
355
1,1-Dichloroethene
355
1,2-Dichloroethene
356
Dichloromethane
357
1,2-Dichloropropane
358
1,3-Dichloropropane
359
1,3-Dichloropropene
359
Dichlorprop
360
Di(2-ethylhexyl)adipate
361
Di(2-ethylhexyl)phthalate
361
Dimethoate
362
1,4-Dioxane
363
Diquat
364
Edetic acid
364
Endosulfan
365
Endrin
366
Epichlorohydrin
367
Ethylbenzene
368
Fenitrothion
368
Fenoprop
369
Fluoride
370
Formaldehyde
373
Glyphosate and AMPA
374
Halogenated acetonitriles (dichloroacetonitrile,
dibromoacetonitrile, bromochloroacetonitrile,
trichloroacetonitrile)
375
Hardness
376
Heptachlor and heptachlor epoxide
377
Hexachlorobenzene
378
Hexachlorobutadiene
379
Hydrogen sulfide
380
xi
Inorganic tin
Iodine
Iron
Isoproturon
Lead
Lindane
Malathion
Manganese
MCPA
Mecoprop
Mercury
Methoxychlor
Methyl parathion
Methyl tertiary-butyl ether
Metolachlor
Molinate
Molybdenum
Monochloroacetic acid
Monochlorobenzene
MX
Nickel
Nitrate and nitrite
Nitrilotriacetic acid
Nitrobenzene
N-Nitrosodimethylamine
Parathion
Pendimethalin
Pentachlorophenol
Petroleum products
pH
2-Phenylphenol and its sodium salt
Polynuclear aromatic hydrocarbons
Potassium
Propanil
Selenium
Silver
Simazine
Sodium
Sodium dichloroisocyanurate
Styrene
Sulfate
2,4,5-T
Terbuthylazine
Tetrachloroethene
Toluene
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380
381
381
382
383
385
386
386
387
388
389
390
391
392
393
393
394
395
395
396
396
398
403
404
405
406
407
407
408
409
409
410
412
413
413
415
415
416
416
418
419
419
420
421
422
CONTENTS
Total dissolved solids
Trichloroacetic acid
Trichlorobenzenes (total)
1,1,1-Trichloroethane
Trichloroethene
Trifluralin
Trihalomethanes (bromoform, bromodichloromethane,
dibromochloromethane, chloroform)
Uranium
Vinyl chloride
Xylenes
Zinc
12.2 Pesticides used for vector control in drinking-water sources and
containers
Bacillus thuringensis israelensis
Diflubenzuron
Methoprene
Novaluron
Permethrin
Pirimiphos-methyl
Pyriproxyfen
Spinosad
Temephos
Annex 1
Annex 2
Annex 3
Annex 4
Annex 5
Annex 6
Annex 7
Index
423
423
424
424
425
426
427
430
431
432
433
434
434
435
436
437
438
438
439
440
441
443
449
468
476
485
504
509
518
xiii
Preface
ccess to safe drinking-water is essential to health, a basic human right and a component of effective policy for health protection.
The importance of water, sanitation and hygiene for health and development
has been reflected in the outcomes of a series of international policy forums. These
have included health-oriented conferences such as the International Conference on
Primary Health Care, held in Alma-Ata, Kazakhstan (former Soviet Union), in 1978.
They have also included water-oriented conferences such as the 1977 World Water
Conference in Mar del Plata, Argentina, which launched the water supply and sanitation decade of 19811990, as well as the Millennium Development Goals adopted by
the General Assembly of the United Nations (UN) in 2000 and the outcome of the
Johannesburg World Summit for Sustainable Development in 2002. The UN General
Assembly declared the period from 2005 to 2015 as the International Decade for Action, Water for Life. Most recently, the UN General Assembly declared safe and clean
drinking-water and sanitation a human right essential to the full enjoyment of life and
all other human rights.
Access to safe drinking-water is important as a health and development issue at
national, regional and local levels. In some regions, it has been shown that investments
in water supply and sanitation can yield a net economic benefit, as the reductions
in adverse health effects and health-care costs outweigh the costs of undertaking the
interventions. This is true for investments ranging from major water supply infrastructure through to water treatment in the home. Experience has also shown that
interventions in improving access to safe water favour the poor in particular, whether
in rural or urban areas, and can be an effective part of poverty alleviation strategies.
The World Health Organization (WHO) published three editions of the Guidelines for drinking-water quality in 19831984, 19931997 and 2004, as successors to
previous WHO International standards for drinking water, published in 1958, 1963
and 1971. From 1995, the Guidelines have been kept up to date through a process of
rolling revision, which leads to the regular publication of addenda that may add to
or supersede information in previous volumes as well as expert reviews on key issues
preparatory to the development of the Guidelines.
Leading the process of the development of the fourth edition was the Water, Sanitation, Hygiene and Health Unit within WHO Headquarters, with the Programme on
xv
Chemical Safety providing input on chemical hazards and the Radiation and Environmental Health Unit providing input on radiological hazards. All six WHO Regional
Offices participated in the process, in consultation with Member States.
This edition of the Guidelines for drinking-water quality integrates the third edition, which was published in 2004, with both the first addendum to the third edition,
published in 2006, and the second addendum to the third edition, published in 2008.
It supersedes previous editions of the Guidelines and previous International Standards.
This edition of the Guidelines further develops concepts, approaches and information introduced in previous editions, including the comprehensive preventive risk
management approach for ensuring drinking-water quality that was introduced in the
third edition. It considers:
and developed countries. Experience has shown the value of a systematic approach
to securing microbial safety. This edition builds on the preventive principles
introduced in the third edition on ensuring the microbial safety of drinkingwater through a multiple-barrier approach, highlighting the importance of source
water protection;
climate change, which results in changing water temperature and rainfall patterns,
severe and prolonged drought or increased flooding, and its implications for
water quality and water scarcity, recognizing the importance of managing these
impacts as part of water management strategies;
chemical contaminants in drinking-water, including information on chemicals
not considered previously, such as pesticides used for vector control in drinkingwater; revisions of existing chemical fact sheets, taking account of new scientific
information; and, in some cases, reduced coverage in the Guidelines where new
information suggests a lesser priority;
those key chemicals responsible for large-scale health effects through drinkingwater exposure, including arsenic, fluoride, lead, nitrate, selenium and uranium,
providing guidance on identifying local priorities and on management;
the important roles of many different stakeholders in ensuring drinking-water
safety. This edition furthers the discussion introduced in the third edition of the
roles and responsibilities of key stakeholders in ensuring drinking-water safety;
guidance in situations other than traditional community supplies or managed
utilities, such as rainwater harvesting and other non-piped supplies or dual piped
systems.
This edition of the Guidelines is accompanied by a series of supporting publications. These include internationally peer-reviewed risk assessments for specific chemicals (see list of chapter 12 background documents in Annex 2) and other publications
explaining the scientific basis of the development of the Guidelines and providing
guidance on good practice in their implementation (see Annex 1). The Guidelines
xvi
Preface
xvii
Acknowledgements
Acknowledgements
xix
2,4-D
2,4-DB
2,4-DP
2,4,5-T
2,4,5-TP
2,4-dichlorophenoxyacetic acid
2,4-dichlorophenoxybutyric acid
dichlorprop
2,4,5-trichlorophenoxyacetic acid
2,4,5-trichlorophenoxy propionic acid; fenoprop
AAS
Absor
ADI
AES
AIDS
AMPA
ARfD
BDCM
BMD
BMDL
BTEX
Bti
bw
bromodichloromethane
benchmark dose
lower confidence limit on the benchmark dose
benzene, toluene, ethylbenzene and xylenes
Bacillus thuringiensis israelensis
body weight
CAS
Col
CSAF
Ct
DAEC
DALY
DBCM
DBCP
DBP
DCA
DCB
DCP
DDT
DEHA
DEHP
DNA
dibromochloromethane
1,2-dibromo-3-chloropropane
disinfection by-product
dichloroacetic acid
dichlorobenzene
dichloropropane
dichlorodiphenyltrichloroethane
di(2-ethylhexyl)adipate
di(2-ethylhexyl)phthalate
deoxyribonucleic acid
EAAS
EAEC
ECD
EDTA
EHEC
EIEC
ELISA
EPEC
ETEC
FAAS
FAO
FD
FID
FPD
GAC
GC
GL
GV
HAA
HAV
HCB
HCBD
HCH
HEV
HIV
HPC
HPLC
haloacetic acid
hepatitis A virus
hexachlorobenzene
hexachlorobutadiene
hexachlorocyclohexane
hepatitis E virus
human immunodeficiency virus
heterotrophic plate count
high-performance liquid chromatography
xxi
IARC
IC
ICP
ICRP
IDC
IPCS
IQ
ISO
JECFA
JMPR
LC
LOAEL
LRV
liquid chromatography
lowest-observed-adverse-effect level
log10 reduction value
MCB
MCPA
MCPB
MCPP
MMT
MS
MTBE
MX
monochlorobenzene
4-(2-methyl-4-chlorophenoxy)acetic acid
2,4-MCPB; 4-(4-chloro-o-tolyloxy)butyric acid;
4-(4-chloro-2-methylphenoxy)butanoic acid
2(2-methyl-chlorophenoxy)propionic acid; mecoprop
methylcyclopentadienyl manganese tricarbonyl
mass spectrometry
methyl tertiary-butyl ether
3-chloro-4-dichloromethyl-5-hydroxy-2(5H)-furanone
NDMA
NOAEL
NOEL
NTA
NTP
NTU
N-nitrosodimethylamine
no-observed-adverse-effect level
no-observed-effect level
nitrilotriacetic acid
National Toxicology Program (USA)
nephelometric turbidity unit
PAC
PAH
PCP
PCR
PD
PMTDI
PPA
PT
PTDI
PTMI
PTWI
PVC
QMRA
RNA
ribonucleic acid
SI
SODIS
sp.
spp.
subsp.
TBA
TCB
TCU
TD05
TDI
TDS
THM
TID
UF
UN
UNICEF
UNSCEAR
terbuthylazine
trichlorobenzene
true colour unit
tumorigenic dose05, the dose associated with a 5% excess
incidence of tumours in experimental animal studies
tolerable daily intake
total dissolved solids
trihalomethane
thermal ionization detector; total indicative dose
USA
UV
UVPAD
uncertainty factor
United Nations
United Nations Childrens Fund
United Nations Scientific Committee on the Effects of
Atomic Radiation
United States of America
ultraviolet
ultraviolet photodiode array detector
WHO
WHOPES
WSP
YLD
YLL
xxiii
1
Introduction
Introduction
(Chapter 1)
he primary purpose
of the Guidelines for
drinking-water quality is
the protection of public
health. The Guidelines
provide the recommendations of the World Health
Organization (WHO) for
managing the risk from
hazards that may compromise the safety of
drinking-water. The recommendations should be
considered in the context
of managing the risk from
other sources of exposure
to these hazards, such as
waste, air, food and consumer products.
Monitoring
Management and
communication
Surveillance
(Chapter 5)
SUPPORTING
INFORMATION
Microbial aspects
(Chapters 7 and 11)
Chemical aspects
(Chapters 8 and 12)
Radiological
aspects
(Chapter 9)
Acceptability
aspects
(Chapter 10)
1. INTRODUCTION
The judgement of safetyor what is an acceptable level of risk in particular circumstancesis a matter in which society as a whole has a role to play. The final judgement as
to whether the benefit resulting from the adoption of any of the Guidelines or guideline
values as national or local standards justifies the cost is for each country to decide.
Although the Guidelines describe a quality of water that is acceptable for lifelong consumption, the establishment of these Guidelines, including guideline values,
should not be regarded as implying that the quality of drinking-water may be degraded to the recommended level. Indeed, a continuous effort should be made to maintain
drinking-water quality at the highest possible level.
An important concept in the allocation of resources to improving drinking-water
safety is that of incremental improvement towards long-term health-based targets.
Priorities set to remedy the most urgent
problems (e.g. protection from pathoAn important concept in the allocation
gens; see section 1.1.2) may be linked to
of resources to improving drinking-water
safety is that of incremental improvement
long-term targets of further water qualtowards long-term water quality targets.
ity improvements (e.g. improvements in
the acceptability of drinking-water in
terms of its taste, odour and appearance;
see section 1.1.6).
1.1.1 Framework for safe drinking-water
The basic and essential requirements to ensure the safety of drinking-water are a
framework for safe drinking-water, comprising health-based targets established by a
competent health authority, adequate and properly managed systems (adequate infrastructure, proper monitoring and effective planning and management) and a system
of independent surveillance.
A holistic approach to the risk assessment and risk management of a drinkingwater supply increases confidence in the safety of the drinking-water. This approach
entails systematic assessment of risks throughout a drinking-water supplyfrom the
catchment and its source water through to the consumerand identification of the
ways in which these risks
can be managed, including
In Stockholm, in 1999, it was agreed that future guidelines for
methods to ensure that condrinking-water, wastewater and recreational water should
integrate assessment of risk, risk management options and
trol measures are working
exposure control elements within a single framework with
effectively. It incorporates
embedded quality targets (see the supporting document
strategies to deal with dayWater qualityGuidelines, standards and health; Annex 1).
to-day management of
Following this approach, the assessment of risk is not a goal
in its own right, but rather a basis for decision-making. The
water quality, including upframework for safe drinking-water and the recommended
sets and failures. In this reapproach for regulations, policies and programmes are
spect, climate changein
based on this overall framework, known as the Stockholm
the form of increased and
Framework (see chapter 2).
more severe periods of
drought or more intense
rainfall events leading to floodingcan have an impact on both the quality and the
quantity of water and will require planning and management to minimize adverse
3
1. INTRODUCTION
Introduction
(Chapter 1)
Monitoring
Microbial aspects
(Chapters 7 and 11)
Chemical aspects
(Chapters 8 and 12)
SUPPORTING
INFORMATION
Radiological
aspects
(Chapter 9)
Management and
communication
Acceptability
aspects
(Chapter 10)
Surveillance
(Chapter 5)
Figure 1.1
Interrelationships among the individual chapters of the Guidelines for drinkingwater quality in ensuring drinking-water safety
1. INTRODUCTION
There are many chemicals that may occur in drinking-water; however, only a few
are of immediate health concern in any given circumstance. The priority given to both
monitoring and remedial action for chemical contaminants in drinking-water should
be managed to ensure that scarce resources are not unnecessarily directed towards
those of little or no health concern (see the supporting document Chemical safety of
drinking-water; Annex 1).
There are few chemicals for which the contribution from drinking-water to
overall intake is an important factor in preventing disease. One example is the effect
of fluoride in drinking-water in protecting against dental caries. The Guidelines do
not attempt to define minimum desirable concentrations for chemicals in drinkingwater.
Guideline values are derived for many chemical constituents of drinking-water.
A guideline value normally represents the concentration of a constituent that does
not result in any significant risk to health over a lifetime of consumption. A number
of provisional guideline values have been established based on the practical level of
treatment performance or analytical achievability. In these cases, the guideline value is
higher than the calculated health-based value.
The chemical aspects of drinking-water quality are considered in more detail in
chapter 8, with fact sheets on specific chemical contaminants provided in chapter 12.
1.1.5 Radiological aspects
The health risks associated with the presence of naturally occurring radionuclides in
drinking-water should also be taken into consideration, although the contribution of
drinking-water to total exposure to radionuclides is very small under normal circumstances.
Formal guideline values are not set for individual radionuclides in drinkingwater. Rather, the approach used is based on screening drinking-water for gross alpha
and gross beta radiation activity. Although finding levels of activity above screening
values does not indicate any immediate risk to health, it should trigger further investigation to determine the radionuclides responsible and the possible risks, taking local
circumstances into account.
The guidance levels for radionuclides recommended in these Guidelines do not
apply to drinking-water supplies contaminated during emergencies arising from accidental releases of radioactive substances to the environment.
Radiological aspects of drinking-water quality are considered in more detail in
chapter 9.
1.1.6 Acceptability aspects: taste, odour and appearance
Water should be free of tastes and odours that would be objectionable to the majority
of consumers.
In assessing the quality of drinking-water, consumers rely principally upon their
senses. Microbial, chemical and physical constituents of water may affect the appearance, odour or taste of the water, and the consumer will evaluate the quality and acceptability of the water on the basis of these criteria. Although these constituents may
have no direct health effects, water that is highly turbid, is highly coloured or has an
7
1. INTRODUCTION
sible for surveillance and of the water supplier. The two functions of surveillance and
quality control are best performed by separate and independent entities because of the
conflict of interest that arises when the two are combined. In this:
required to ensure and verify that the systems they administer are capable of
delivering safe water and that they routinely achieve this;
a surveillance agency is responsible for independent (external) surveillance
through periodic audit of all aspects of safety and/or verification testing.
outbreak detection;
10
1. INTRODUCTION
outbreak investigations;
intervention studies to evaluate intervention options;
casecontrol or cohort studies to evaluate the role of water as a risk factor in
disease.
However, public health surveillance cannot be relied upon to provide information in a timely manner to enable short-term operational response to control waterborne disease. Limitations include:
The public health authority operates reactively, as well as proactively, against the
background of overall public health policy and in interaction with all stakeholders. In
accounting for public health context, priority will normally be afforded to disadvantaged groups. This will generally entail balancing drinking-water safety management
and improvement with the need to ensure access to reliable supplies of safe drinkingwater in adequate quantities.
In order to develop an understanding of the national drinking-water situation,
the national public health authority should periodically produce reports outlining the
state of national water quality and highlighting public health concerns and priorities
in the context of overall public health priorities. This implies the need for effective
exchange of information between local, regional and national agencies.
National health authorities should lead or participate in the formulation and implementation of policy to ensure access to some form of reliable, safe drinking-water
supply. Where this has not been achieved, appropriate tools and education should be
made available to implement individual or household-level treatment and safe storage.
1.2.3 Local authorities
Local environmental health authorities often play an important role in managing
water resources and drinking-water supplies. This may include catchment inspection
and authorization of activities in the catchment that may have an impact on source
water quality. It can also include verifying and auditing (surveillance) of the management of formal drinking-water systems. Local environmental health authorities will
also give specific guidance to communities or individuals in designing and implementing community and household drinking-water systems and correcting deficiencies, and they may also be responsible for surveillance of community and household
11
1. INTRODUCTION
other potentially polluting human activities, such as industry, mining and military
sites.
Water resource management may be the responsibility of catchment management agencies and/or other entities controlling or affecting water resources, such as
industrial, agricultural, navigation and flood control entities.
The extent to which the responsibilities of health or drinking-water supply agencies include water resource management varies greatly between countries and communities. Regardless of government structures and sector responsibilities, it is important that health authorities liaise and collaborate with sectors managing the water
resource and regulating land use in the catchment.
Establishing close collaboration between the public health authority, water
supplier and resource management agency assists recognition of the health hazards
potentially occurring in the system. It is also important for ensuring that the protection of drinking-water resources is considered in decisions for land use or regulations
to control contamination of water resources. Depending on the setting, this may
include involvement of further sectors, such as agriculture, traffic, tourism or urban
development.
To ensure the adequate protection of drinking-water sources, national authorities
will normally interact with other sectors in formulating national policy for integrated water resource management. Regional and local structures for implementing the
policy will be set up, and national authorities will guide regional and local authorities
by providing tools.
Regional environmental or public health authorities have an important task in
participating in the preparation of integrated water resource management plans to
ensure the best available drinking-water source quality. For further information, see
the supporting document Protecting groundwater for health (see Annex 1).
1.2.5 Drinking-water supply agencies
Drinking-water supplies vary from very large urban systems servicing large populations with tens of millions of people to small community systems providing water to
very small populations. In most countries, they include community sources as well as
piped means of supply.
Drinking-water supply agencies are responsible for quality assurance and quality
control (see section 1.2.1). Their key responsibilities are to prepare and implement
water safety plans (for more information, see chapter 4).
In many cases, the water supplier is not responsible for the management of the
catchment feeding the sources of its supplies. The roles of the water supplier with
respect to catchments are to participate in interagency water resource management
activities, to understand the risks arising from potentially contaminating activities and
incidents and to use this information in assessing risks to the drinking-water supply and developing and applying appropriate management. Although drinking-water
suppliers may not undertake catchment surveys and pollution risk assessment alone,
their role is to recognize the need for them and to initiate multiagency collaboration
for example, with health and environmental authorities.
13
Experience has shown that an association of stakeholders in drinking-water supply (e.g. operators, managers and specialist groups such as small suppliers, scientists,
sociologists, legislators and politicians) can provide a valuable non-threatening forum
for the interchange of ideas.
For further information, see the supporting document Water safety plans (see
Annex 1).
1.2.6 Community management
Community-managed drinking-water systems, with both piped and non-piped distribution, are common worldwide in both developed and developing countries. The precise definition of a community drinking-water system will vary. Although a definition
based on population size or the type of supply may be appropriate under many conditions, approaches to administration and management provide a distinction between
the drinking-water systems of small communities and those of larger towns and cities.
This includes the increased reliance on often untrained and sometimes unpaid community members in the administration and operation of community drinking-water
systems. Drinking-water systems in periurban areasthe communities surrounding
major towns and citiesin developing countries may also have the characteristics of
community systems.
Effective and sustainable programmes for the management of community drinking-water quality require the active support and involvement of local communities.
These communities should be involved at all stages of such programmes, including
initial surveys; decisions on siting of wells, siting of intakes or establishing protection zones; monitoring and surveillance of drinking-water supplies; reporting faults,
carrying out maintenance and taking remedial action; and supportive actions, including sanitation and hygiene practices.
A community may already be highly organized and taking action on health or
drinking-water supply issues. Alternatively, it may lack a well-developed drinkingwater system; some sectors of the community, such as women, may be poorly represented; and there may be disagreements or factional conflicts. In these situations,
achieving community participation will take more time and effort to bring people
together, resolve differences, agree on common aims and take action. Visits, possibly
over several years, will often be needed to provide support and encouragement and to
ensure that the structures created for safe drinking-water supply continue to operate.
This may involve setting up hygiene and health educational programmes to ensure
that the community:
health and of the need for safe drinking-water in sufficient quantities for domestic
use for drinking, cooking and hygiene;
recognizes the importance of surveillance and the need for a community
response;
understands and is prepared to play its role in the surveillance process;
has the necessary skills to perform that role;
is aware of requirements for the protection of drinking-water supplies from
pollution.
14
1. INTRODUCTION
For further information, see the 1997 volume entitled Surveillance and control
of community supplies (WHO, 1997); the supporting document Water safety plans
(Annex 1); Simpson-Hbert, Sawyer & Clarke (1996); Sawyer, Simpson-Hbert &
Wood (1998); and Brikk (2000).
1.2.7 Water vendors
Vendors selling water to households or at collection points are common in many parts
of the world where scarcity of water or faults in or lack of infrastructure limits access
to suitable quantities of drinking-water. Water vendors use a range of modes of transport to carry drinking-water for sale directly to the consumer, including tanker trucks
and wheelbarrows or trolleys. In the context of these Guidelines, water vending does
not include bottled or packaged water (which is considered in section 6.14) or water
sold through vending machines.
There are a number of health concerns associated with water supplied to consumers by water vendors. These include access to adequate volumes and concern regarding
inadequate treatment or transport in inappropriate containers, which can result in
contamination.
More detailed information on treatment of vended water, undertaking a risk assessment of vended water supplies, operational monitoring of control measures, management plans and independent surveillance is included in section 6.3.
1.2.8 Individual consumers
Everyone consumes water from one source or another, and consumers often play
important roles in the collection, treatment and storage of water. Consumer actions
may help to ensure the safety of the water they consume and may also contribute to
improvement or contamination of the water consumed by others. Consumers have
the responsibility for ensuring that their actions do not have an adverse impact on
water quality. Installation and maintenance of household plumbing systems should
be undertaken preferably by qualified and authorized plumbers (see section 1.2.10) or
other persons with appropriate expertise to ensure that cross-connections or backflow
events do not result in contamination of local water supplies.
In most countries, there are populations whose water is derived from household
sources, such as private wells and rainwater. In households using non-piped water supplies, appropriate efforts are needed to ensure safe collection, storage and perhaps treatment of their drinking-water. In some circumstances, households and individuals may
wish to treat water in the home to increase their confidence in its safety. This would
be relevant where community supplies are absent or where community supplies are
known to be contaminated or causing waterborne disease (see chapter 7). Public health
surveillance or other local authorities may provide guidance to support households
and individual consumers in ensuring the safety of their drinking-water. Such guidance
is best provided in the context of a community education and training programme.
1.2.9 Certification agencies
Certification is used to verify that devices and materials used in the drinking-water
supply meet a given level of quality and safety. Certification is a process in which
15
certification of products to ensure that their use does not threaten the safety of
the user or the general public, such as by causing contamination of drinkingwater with toxic substances, substances that could affect consumer acceptability
or substances that support the growth of microorganisms;
product testing, to avoid retesting at local levels or prior to each procurement;
ensuring uniform quality and condition of products;
certification and accreditation of analytical and other testing laboratories;
control of materials and chemicals used for the treatment of drinking-water,
including the performance of devices for household use;
ensuring that water safety plans are effective.
An important step in any certification procedure is the establishment of standards, which must form the basis of assessment of the products. These standards
should alsoas far as possiblecontain the criteria for approval. In procedures for
certification on technical aspects, these standards are generally developed in cooperation with the manufacturers, the certifying agency and the consumers. The national
public health authorities should have responsibility for developing the parts of the
approval process or criteria relating directly to public health. For further information
on the control of materials and chemicals used for the treatment of drinking-water,
see section 8.5.4.
1.2.10 Plumbing
Significant adverse health effects have been associated with inadequate plumbing systems within public and private buildings arising from poor design, incorrect installation, alterations and inadequate maintenance.
16
1. INTRODUCTION
Numerous factors influence the quality of water within a buildings piped distribution system and may result in microbial or chemical contamination of drinkingwater. Outbreaks of gastrointestinal disease can occur through faecal contamination
of drinking-water within buildings arising from deficiencies in roof storage tanks
and cross-connections with wastewater pipes, for example. Poorly designed plumbing systems can cause stagnation of water and provide a suitable environment for the
proliferation of Legionella. Plumbing materials, pipes, fittings and coatings can result
in elevated heavy metal (e.g. lead) concentrations in drinking-water, and inappropriate materials can be conducive to bacterial growth. Potential adverse health effects
may not be confined to the individual building. Exposure of other consumers to contaminants is possible through contamination of the local public distribution system,
beyond the particular building, through cross-contamination of drinking-water and
backflow.
The delivery of water that complies with relevant standards within buildings generally relies on a plumbing system that is not directly managed by the water supplier.
Reliance is therefore placed on proper installation of plumbing and, for larger buildings, on building-specific water safety plans (see section 6.9).
To ensure the safety of drinking-water supplies within the building system,
plumbing practices must prevent the introduction of hazards to health. This can be
achieved by ensuring that:
pipes carrying either water or wastes are watertight, durable, of smooth and
unobstructed interior and protected against anticipated stresses;
roof storage systems are intact and not subject to intrusion of microbial or
chemical contaminants;
hot and cold water systems are designed to minimize the proliferation of Legionella
17
18
2
A conceptual framework for
implementing the Guidelines
Introduction
(Chapter 1)
19
2) water safety plans (WSPs), comprising (section 2.2 and chapter 4):
a system assessment to determine whether the drinking-water supply (from
source through treatment to the point of consumption) as a whole can deliver
water of a quality that meets the health-based targets (section 4.1);
operational monitoring of the control measures in the drinking-water supply that
are of particular importance in securing drinking-water safety (section 4.2);
management plans documenting the system assessment and monitoring
plans and describing actions to be taken in normal operation and incident
conditions, including upgrade and improvement, documentation and
communication (sections 4.44.6);
3) a system of independent surveillance that verifies that the above are operating
properly (section 2.3 and chapter 5).
Verification to determine whether the performance of the drinking-water supply is in
compliance with the health-based targets and whether the WSP itself is effective may
be undertaken by the supplier, surveillance agencies or a combination of the two (see
section 4.3).
23
The use of indicator organisms (see section 11.6) in the monitoring of water
quality is discussed in the supporting document Assessing microbial safety of drinking water (see Annex 1), and operational monitoring is considered in more detail in
control measures and operational monitoring and verification plans and performance consistency;
training programmes;
research and development;
procedures for evaluating results and reporting;
performance evaluations, audits and reviews;
communication protocols;
community consultation.
Documentation and record systems should be kept as simple and focused as possible. The level of detail in the documentation of procedures should be sufficient to
provide assurance of operational control when coupled with suitably qualified and
competent operators.
Mechanisms should be established to periodically review and, where necessary,
revise documents to reflect changing circumstances. Documents should be assembled
in a manner that will enable any necessary modifications to be made easily. A document control system should be developed to ensure that current versions are in use
and obsolete documents are discarded.
24
2.3 Surveillance
Surveillance agencies are responsible for an independent (external) and periodic review of all aspects of quality and public health safety and should have the power to
investigate and to compel action to respond to and rectify incidents of contamination-caused outbreaks of waterborne disease or other threats to public health. The
act of surveillance includes identifying potential drinking-water contamination and
waterborne illness events and, more proactively, assessing compliance with WSPs and
promoting improvement of the quality, quantity, accessibility, coverage, affordability
and continuity of drinking-water supplies.
Surveillance of drinking-water requires a systematic programme of data collection and surveys that may include auditing of WSPs, analysis, sanitary inspection and
institutional and community aspects. It should cover the whole of the drinking-water
system, including sources and activities in the catchment, transmission infrastructure,
whether piped or unpiped, treatment plants, storage reservoirs and distribution systems.
As incremental improvement and prioritizing action in systems presenting greatest overall risk to public health are important, there are advantages to adopting a grading scheme for the relative safety of drinking-water supplies (see chapter 4). More
sophisticated grading schemes may be of particular use in community supplies where
the frequency of testing is low and exclusive reliance on analytical results is particularly inappropriate. Such schemes will typically take account of both analytical findings
and sanitary inspection through approaches such as those presented in section 4.1.2.
The role of surveillance is discussed in section 1.2.1 and chapter 5.
25
supply is in compliance with the stated objectives outlined by the health-based targets
and whether the WSP needs modification or revalidation.
Verification of drinking-water may be undertaken by the supplier, surveillance
agencies or a combination of the two (see section 4.3). Although verification is most
commonly carried out by the surveillance agency, a utility-led verification programme
can provide an additional level of confidence, supplementing regulations that specify
monitoring parameters and frequencies.
2.4.1 Microbial water quality
For microbial water quality, verification is likely to be based on the analysis of faecal
indicator microorganisms, with the organism of choice being Escherichia coli or, alternatively, thermotolerant coliforms (see sections 4.3.1, 7.4 and 11.6). Monitoring
of specific pathogens may be included on very limited occasions to verify that an
outbreak was waterborne or that a WSP has been effective. Escherichia coli provides
conclusive evidence of recent faecal pollution and should not be present in drinkingwater. Under certain circumstances, additional indicators, such as bacteriophages or
bacterial spores, may be used.
However, water quality can vary rapidly, and all systems are at risk of occasional
failure. For example, rainfall can greatly increase the levels of microbial contamination
in source waters, and waterborne outbreaks often occur following rainfall. Results of
analytical testing must be interpreted taking this into account.
2.4.2 Chemical water quality
Assessment of the adequacy of the chemical quality of drinking-water relies on comparison of the results of water quality analysis with guideline values. These Guidelines
provide guideline values for many more chemical contaminants than will actually affect any particular water supply, so judicious choices for monitoring and surveillance
should be made prior to initiating an analytical chemical assessment.
For additives (i.e. chemicals deriving primarily from materials and chemicals used
in the production and distribution of drinking-water), emphasis is placed on the direct control of the quality of these commercial products. In controlling drinking-water
additives, testing procedures typically assess whether the product meets the specifications (see section 8.5.4).
As indicated in chapter 1, most chemicals are of concern only following longterm exposure; however, some hazardous chemicals that occur in drinking-water are
of concern because of effects arising from sequences of exposures over a short period.
Where the concentration of the chemical of interest (e.g. nitrate/nitrite, which is associated with methaemoglobinaemia in bottle-fed infants) varies widely, even a series
of analytical results may fail to fully identify and describe the public health risk. In
controlling such hazards, attention must be given to both knowledge of causal factors
such as fertilizer use in agriculture and trends in detected concentrations, as these
will indicate whether a significant problem may arise in the future. Other hazards
may arise intermittently, often associated with seasonal activity or seasonal conditions.
One example is the occurrence of blooms of toxic cyanobacteria in surface water.
26
Many microbial and chemical constituents of drinkingwater can potentially cause adverse human health effects. The detection of these constituents in both raw
water and water delivered to consumers is often slow,
complex and costly, which limits early warning capability and affordability. Reliance on water quality determination alone is insufficient to protect public health. As it
is neither physically nor economically feasible to test for
all drinking-water quality parameters, the use of monitoring effort and resources should be carefully planned
and directed at significant or key characteristics.
27
microbial hazards, the setting of targets will be influenced by occurrence and concentrations in source waters and the relative contribution of waterborne organisms to
disease. For chemical hazards, the factors to be considered are the severity of health
effects and the frequency of exposure of the population in combination with the concentration to which they will be exposed. The probability of health effects clearly depends on the toxicity and the concentration, but it also depends on the period of
exposure. For most chemicals, health impacts are associated with long-term exposure.
Hence, in the event that exposure is occasional, the risk of an adverse health effect is
likely to be low, unless the concentration is extremely high. The substances of highest priority will therefore be those that occur widely, are present in drinking-water
sources or drinking-water all or most of the time and are present at concentrations
that are of health concern.
Guidance on determining which chemicals are of importance in a particular situation is given in the supporting document Chemical safety of drinking-water
(Annex 1).
Although WHO does not set formal guideline values for substances on the basis
of consumer acceptability (i.e. substances that affect the appearance, taste or odour
of drinking-water), it is not uncommon for standards to be set for substances and
parameters that relate to consumer acceptability. Although exceeding such a standard
is not a direct issue for health, it may be of great significance for consumer confidence
and may lead consumers to obtain their water from an alternative, less safe source.
Such standards are usually based on local considerations of acceptability.
Priority setting should be undertaken on the basis of a systematic assessment
based on collaborative effort among all relevant agencies and may be applied at national and system-specific levels. At the national level, priorities need to be set in order
to identify the relevant hazards, based on an assessment of riski.e. severity and exposure. At the level of individual water supplies, it may be necessary to also prioritize
constituents for effective system management. These processes may require the input
of a broad range of stakeholders, including health, water resources, drinking-water
supply, environment, agriculture and geological services/mining authorities, to establish a mechanism for sharing information and reaching consensus on drinking-water
quality issues.
2.5.1 Undertaking a drinking-water quality assessment
In order to determine which constituents are, indeed, of concern, it will be necessary
to undertake a drinking-water quality assessment. It is important to identify what
types of drinking-water systems are in place in the country (e.g. piped water supplies,
non-piped water supplies, vended water) and the quality of drinking-water sources
and supplies.
Additional information that should be considered in the assessment includes
catchment type (protected, unprotected), wastewater discharges, geology, topography,
agricultural land use, industrial activities, sanitary surveys, records of previous monitoring, inspections and local and community knowledge. The wider the range of data
sources used, the more useful the results of the process will be.
28
In many situations, authorities or consumers may have already identified a number of drinking-water quality problems, particularly where they cause obvious health
effects or acceptability problems. These existing problems would normally be assigned
a high priority.
Drinking-water supplies that represent the greatest risks to public health should
be identified, with resources allocated accordingly.
2.5.2 Assessing microbial priorities
The most common and widespread health risk associated with drinking-water is
microbial contamination, the consequences of which mean that its control
The most common and widespread health
must always be of paramount importrisk associated with drinking-water is microbial contamination, the consequences
ance. Priority needs to be given to
of which mean that its control must always
improving and developing the drinkingbe of paramount importance.
water supplies that represent the greatest
public health risk.
Health-based targets for microbial contaminants are discussed in section 3.2, and
a comprehensive consideration of microbial aspects of drinking-water quality is contained in chapter 7.
2.5.3 Assessing chemical priorities
Not all of the chemicals with guideline values will be present in all water supplies or,
indeed, all countries. If they do exist, they may not be found at levels of concern. Conversely, some chemicals without guideline values or not addressed in the Guidelines
may nevertheless be of legitimate local concern under special circumstances.
Risk management strategies (as reflected in national standards and monitoring
activities) and commitment of resources should give priority to those chemicals that
pose a risk to human health or to those with significant impacts on the acceptability
of water.
Only a few chemicals have been shown to cause widespread health effects in humans as a consequence of exposure through drinking-water when they are present in
excessive quantities. These include fluoride, arsenic and nitrate. Human health effects
associated with lead (from domestic plumbing) have also been demonstrated in some
areas, and there is concern because of the potential extent of exposure to selenium and
uranium in some areas at concentrations of human health significance. Iron and manganese are of widespread significance because of their effects on acceptability. These
constituents should be taken into consideration as part of any priority-setting process.
In some cases, assessment will indicate that no risk of significant exposure exists at the
national, regional or system level.
Drinking-water may be only a minor contributor to the overall exposure to a
particular chemical, and in some circumstances controlling the levels in drinkingwater, at potentially considerable expense, may have little impact on overall exposure.
Drinking-water risk management strategies should therefore be considered in conjunction with other potential sources of human exposure.
29
The process of short-listing chemicals of concern may initially be a simple classification of high and low risk to identify broad issues. This may be refined using data
from more detailed assessments and analysis and may take into consideration rare
events, variability and uncertainty.
Guidance on how to undertake prioritization of chemicals in drinking-water is
provided in the supporting document Chemical safety of drinking-water (Annex 1).
This deals with issues including:
the concentration of the chemical that is likely to give rise to health effects (see
also section 8.5);
the evidence of health effects or exposure arising through drinking-water, as opposed to other sources, and relative ease of control of the different sources of
exposure.
Additional information on the hazards and risks of many chemicals not included
in these Guidelines is available from several sources, including WHO Environmental
Health Criteria monographs and Concise International Chemical Assessment Documents, reports by the Joint Food and Agriculture Organization of the United Nations (FAO)/WHO Meeting on Pesticide Residues and the Joint FAO/WHO Expert
Committee on Food Additives and information from competent national authorities.
These information sources have been peer reviewed and provide readily accessible information on toxicology, hazards and risks of many less common contaminants. They
can help water suppliers and health officials to decide upon the significance (if any) of
a detected chemical and on the response that might be appropriate.
cess. Public health agencies may be closer to the community than those responsible
for its drinking-water supply. At a local level, they also interact with other sectors
(e.g. education), and their combined action is essential to ensure active community
involvement.
2.6.1 Adapting guideline values to locally relevant standards
In order to account for variations in exposure from different sources (e.g. water, food)
in different parts of the world, the proportion of the tolerable daily intake allocated
to drinking-water in setting guideline values for many chemicals will vary. Where
relevant exposure data are available, authorities are encouraged to develop contextspecific guideline values that are tailored to local circumstances and conditions. For
example, in areas where the intake of a particular contaminant in drinking-water is
known to be much greater than that from other sources (e.g. air and food), it may be
appropriate to allocate a greater proportion of the tolerable daily intake to drinkingwater to derive a guideline value more suited to the local conditions.
Daily water intake can vary significantly in different parts of the world, seasonally and particularly where consumers are involved in manual labour in hot climates.
Local adjustments to the daily water consumption value may be needed in setting local standards, as in the case of fluoride, for example.
Volatile substances in water may be released into the air during showering and
through a range of other household activities. Under such circumstances, inhalation
may become a significant route of exposure. Where such exposure is shown to be important for a particular substance (i.e. high volatility, low ventilation rates and high
rates of showering/bathing), it may be appropriate to adjust the guideline value. For
those substances that are particularly volatile, such as chloroform, the correction factor would be approximately equivalent to a doubling of exposure. For further details,
the reader should refer to section 8.2.9.
2.6.2 Periodic review and revision of standards
As knowledge increases, there may be changes to specific guideline values or consideration of new hazards for the safety of drinking-water. There will also be changes in
the technology of drinking-water treatment and analytical methods for contaminants.
National or subnational standards must therefore be subjected to periodic review and
should be structured in such a way that changes can be made readily. Changes may
need to be made to modify standards, remove parameters or add new parameters, but
no changes should be made without proper justification through risk assessment and
prioritization of resources for protecting public health. Where changes are justified, it
is important that they are communicated to all stakeholders.
31
2.7.1 Regulations
The alignment of national drinking-water quality regulations with the principles outlined in these Guidelines will ensure that:
there is an explicit link between drinking-water quality regulations and the protection of public health;
regulations are based on good practices that have been proven to be appropriate
and effective over time;
a variety of tools are in place to build and ensure compliance with regulations, in
cluding education and training programmes, incentives to encourage good practices and penalties, if enforcement is required;
regulations are appropriate and realistic within national, subnational and local
contexts, including specific provisions or approaches for certain contexts or types
of supplies, such as small community water supplies;
stakeholder roles and responsibilities, including how they should work together,
are clearly defined;
what, when and how information is shared between stakeholdersincluding
consumersand required action is clearly defined for normal operations and in
response to incidents or emergencies;
regulations are adaptable to reflect changes in contexts, understanding and
technological innovation and are periodically reviewed and updated;
regulations are supported by appropriate policies and programmes.
The aim of drinking-water quality regulations should be to ensure that the consumer has access to sustainable, sufficient and safe drinking-water. Enabling legislation should provide broad powers and scope to related regulations and include public
health protection objectives, such as the prevention of waterborne disease and the
provision of an adequate supply of drinking-water. Drinking-water regulations should
focus on improvements to the provision and safety of drinking-water through a variety of requirements, tools and compliance strategies. Although sanctions are needed
within regulations, the principal aim is not to shut down deficient water supplies.
Drinking-water quality regulations are not the only mechanism by which public
health can be protected. Other regulatory mechanisms include those related to source
water protection, infrastructure, water treatment and delivery, surveillance and response to potential contamination and waterborne illness events.
32
Drinking-water quality regulations may also provide for interim standards, permitted deviations and exemptions as part of a national or regional policy, rather than
as a result of local initiatives. This may take the form of temporary exemptions for certain communities or areas for defined periods of time. Short-term and medium-term
targets should be set so that the most significant risks to human health are managed
first. Regulatory frameworks should support long-term progressive improvements.
2.7.2 Supporting policies and programmes
Developing and promulgating regulations alone will not ensure that public health
is protected. Regulations must be supported by adequate policies and programmes.
This includes ensuring that regulatory authorities, such as enforcement agencies, have
sufficient resources to fulfil their responsibilities and that the appropriate policy and
programme supports are in place to assist those required to comply with regulations.
In other words, the appropriate supports need to be in place so that those being regulated and those who are responsible for regulating are not destined to fail.
Implementation or modification of policies and programmes to provide safe
drinking-water should not be delayed because of a lack of appropriate regulation. Even
where drinking-water regulations do not yet exist, it may be possible to encourage,
and even enforce, the supply of safe drinking-water through, for example, educational
efforts or commercial, contractual arrangements between consumer and supplier (e.g.
based on civil law).
In countries where universal access to safe drinking-water at an acceptable level
of service has not been achieved, policies should refer to expressed targets for increases in sustainable access to safe drinking-water. Such policy statements should
be consistent with achievement of the Millennium Development Goals (http://
www.un.org/millenniumgoals/) of the United Nations Millennium Declaration and
should take account of levels of acceptable access outlined in General Comment 15
on the Right to Water of the United Nations Committee on Economic, Social and
Cultural Rights (http://umn.edu/humanrts/gencomm/escgencom15.htm) and associated documents.
33
3
Health-based targets
Introduction
(Chapter 1)
ealth-based targets
are
measurable
health, water quality or
performance objectives
that are established based
on a judgement of safety
and on risk assessments
of waterborne hazards.
These Guidelines describe four distinct types
of health-based targets,
applicable to all types of
hazards and water supplies:
Health-based targets
(Chapter 3)
Monitoring
Management and
communication
Surveillance
(Chapter 5)
SUPPORTING
INFORMATION
Microbial aspects
(Chapters 7 and 11)
Chemical aspects
(Chapters 8 and 12)
Radiological
aspects
(Chapter 9)
Acceptability
aspects
(Chapter 10)
35
3. HEALTH-BASED TARGETS
Benefit
Formulation
Implementation
Evaluation
resources all contribute to drinking-water safety (Howard et al., 2002). Public health
prioritization would normally indicate that the major contributors to disease should
be dealt with preferentially, taking account of the costs and impacts of potential interventions. However, this does not mean ignoring lesser targets if they can be easily
achieved for little cost, as long as this does not divert attention from major targets.
An important concept in the allocation of resources to improving drinking-water
safety is the possibility of establishing less stringent transitional targets supported by
sound risk management systems in order to encourage incremental improvements of
the quality of drinking-water. In this regard, health-based targets can be used as the
basis for supporting and measuring incremental progress in water quality improvement. Improvements can relate to progression through increasingly tighter targets or
evolution through target types that more precisely reflect the health protection goals
(e.g. from specified technology targets to performance targets).
The processes of formulating, implementing, communicating and evaluating
health-based targets provide benefits to the overall preventive management of drinkingwater quality. These benefits are outlined in Table 3.1.
Descriptions of tolerable burdens of disease relating to water are typically expressed in terms of specific health outcomes such as maximum frequencies of diarrhoeal disease or cancer incidence. However, these descriptions do not consider the
severity of the outcomes. The various hazards that may be present in water are associated with very diverse health outcomes with different impacts ranging from mild
diarrhoea to potentially severe outcomes such as typhoid, cancer or skeletal fluorosis.
A common metric is needed that can be used to quantify and compare the burden of disease associated with different water-related hazards, taking into account
varying probabilities, severities and duration of effects. Such a metric should be applicable regardless of the type of hazard (microbial, chemical or radiological) to enable the use of a consistent approach for each hazard. The metric used in these Guidelines is the disability-adjusted life year, or DALY (Box 3.1). The World Health
Organization has used DALYs quite extensively to evaluate public health priorities and
to assess the disease burden associated with environmental exposures, particularly for
microbial hazards.
A key advantage of using
the DALY is its aggregation of
Tolerable burden of disease represents an upper
limit of the burden of health effects associated with
different impacts on the quality
waterborne disease that is established by national
and quantity of life and its focus
policy-makers. Reference level of risk is an equivaon actual outcomes rather than
lent term used in the context of quantitative risk
potential risks; hence, it supports
assessments.
rational public health priority
setting. DALYs can be used to
define tolerable burden of disease and the related reference level of risk.
In these Guidelines, the tolerable burden of disease is defined as an upper limit
of 106 DALY per person per year. This upper-limit DALY is approximately equivalent
to a 105 excess lifetime risk of cancer (i.e. 1 excess case of cancer per 100 000 people
ingesting drinking-water at the water quality target daily over a 70-year period), which
is the risk level used in these Guidelines to determine guideline values for genotoxic
carcinogens.
Expressing health-based targets for chemical hazards in DALYs has the advantage
of enabling comparisons with microbial risks. However, use of the DALY approach for
chemicals has been limited in practice due to gaps in knowledge.
The 106 DALY tolerable burden of disease target may not be achievable or realistic in some locations and circumstances in the near term. Where the overall burden
of disease by multiple exposure routes (water, food, air, direct personal contact, etc.) is
very high, setting a 106 DALY per person per year level of disease burden from waterborne exposure alone will have little impact on the overall disease burden. Setting a
less stringent level of acceptable risk, such as 105 or 104 DALY per person per year,
from waterborne exposure may be more realistic, yet still consistent with the goals of
providing high-quality, safer water.
3. HEALTH-BASED TARGETS
Infection with Cryptosporidium can cause watery diarrhoea (severity weighting of 0.067) lasting for 7 days with extremely rare deaths in 0.0001% of cases. This equates to a DALY per case of
0.0015.
Further information on the use of DALYs in establishing health-based targets is included in the
supporting document Quantifying public health risk in the WHO Guidelines for drinking-water quality
(Annex 1).
needed for their development and implementation and in relation to the precision
with which the public health benefits of risk management actions can be defined.
The most precise are health outcome targets, which underpin the derivation of the
remaining targets, as shown in Figure 3.1. Each target type is based on those above
it in Table 3.2, and assumptions with default values are introduced in moving down
between target types. The targets towards the top of the table require greater scientific
and technical inputs and are therefore more precisely related to the level of health
protection. Target types at the bottom of Table 3.2 require the least interpretation by
practitioners in implementation, but depend on a number of assumptions (e.g. establishing specified technology targets in the absence of sufficient source water quality
data to apply performance targets for microbial pathogens). Efforts should be made
to collect additional information when critical data for applying the next stage of target setting may not be available. This incremental improvement will ensure that the
health-based targets will be as pertinent as possible to local circumstances.
39
Nature of target
Typical applications
Health
outcome
Defined tolerable
burden of disease
No adverse effect
or negligible risk
Guideline values
Chemical hazards
Water quality
Notes
Performance
Specified
technology
Specified removal
of hazards
Defined
technologies
Radiological water
quality targets are not
normally applied
Microbial hazards
(expressed as log
reductions)
Chemical hazards
(expressed as
percentage removal)
When establishing health-based targets, care should be taken to account for shortterm events and fluctuations in water quality along with steady-state conditions.
This is particularly important when developing performance and specified technology
targets. Short-term water quality can significantly deteriorate, for example, following
heavy rain and during maintenance. Catastrophic events can result in periods of very
degraded source water quality and greatly decreased efficiency in many processes, or
even system failure, greatly increasing the likelihood of a disease outbreak. Events like
these provide additional justification for the long-established multiple-barrier principle in water safety.
For chemical hazards, health-based targets most commonly take the form of
water quality targets, using the guideline values outlined in section 8.5. Performance
targets expressed as percentage removals or specified technology targets can also be
applied to chemical hazards.
40
3. HEALTH-BASED TARGETS
Example 1
Example 2
Example 3
No-observed-adverse-effect level
(Derived through international chemical
risk assessment)
Measured or assumed
concentration of 100 organisms
per litre in source water
Water quality target for fluoride
Apply QMRA
Figure 3.1
For microbial hazards, health-based targets usually take the form of performance
or specified technology targets. The choice of target will be influenced by the number
of data available on source water quality, with performance targets requiring more
information. Water quality targets are typically not developed for pathogens, because
monitoring finished drinking-water for pathogens is not considered a feasible or costeffective option. Concentrations of pathogens equivalent to a health outcome target
of 106 DALY per person per year are typically less than 1 organism per 104105 litres.
Therefore, it is more feasible and cost-effective to monitor for indicator organisms
such as E. coli.
In practice, risks to public health from drinking-water are often attributable to a
single hazard at a time; therefore, in deriving targets, the reference level of risk is applied independently to each hazard.
3.3.1 Health outcome targets
The most direct descriptions of drinking-water safety are health outcome targets, such
as upper limits on frequencies of diarrhoeal disease or cancer incidence. These upper
limits represent tolerable burdens of disease and are typically set at the national level.
They underpin the derivation of water quality, performance and specified technology targets (Figure 3.1). These Guidelines define a tolerable burden of disease of 106
DALY per person per year. For threshold chemicals, the health outcome target is based
on no-observed-adverse-effect levels (see section 8.2).
Health outcome targets must be translated into water quality, performance or
specified technology targets in order to be actioned by the water supplier as part of
the water safety plan.
41
3. HEALTH-BASED TARGETS
ance must be made for the incremental increase over levels found in water sources.
For some materials (e.g. domestic plumbing), assumptions must also account for the
relatively high release of some substances for a short period following installation.
Escherichia coli remains an important indicator of faecal contamination for verification of water quality, but measurements of E. coli do not represent a risk-based
water quality target. The use of E. coli as an indicator organism is discussed in more
detail in chapter 7.
3.3.3 Performance targets
Although performance targets can be applied to chemical hazards, the most common
application is for control of microbial hazards in piped supplies. Performance targets assist in the selection and use of control measures that are capable of preventing
pathogens from breaching the barriers of source protection, treatment and distribution systems or preventing growth within the distribution system.
Performance targets define requirements in relation to source water quality.
Ideally, this should be based on system-specific data; more commonly, however, targets will be specified in relation to broad categories of source water quality and type
(see section 7.2). The derivation of performance targets requires the integration of
factors such as tolerable disease burden (acceptable risk), including severity of disease outcomes, and, for pathogens, quantitative microbial risk assessment (see section
7.2). There are insufficient data, and it is not realistic, to derive performance targets
for all potentially waterborne pathogens. The practical approach is to derive targets
for reference pathogens representing groups of pathogens (e.g. bacteria, viruses and
protozoa). Selection of reference pathogens should take into account variations in susceptibility to treatment as well as local conditions, including prevalence of waterborne
transmission and source water characteristics.
The most common application of performance targets is in identifying appropriate combinations of treatment processes to reduce pathogen concentrations in source
water to a level that will meet health outcome targets and hence be safe. This is normally
expressed in terms of log reductions. Selection of processes requires evidence that they
will meet required performance targets (i.e. validation; see sections 2.2.2 and 4.1.7).
Examples of treatment processes and pathogen reductions are given in section 7.3.
Performance targets can be applied to catchment controls that are aimed at reducing pathogen concentrations through preventive measures and to measures to
prevent ingress of contamination through distribution systems. Performance targets
are also important in certification of point-of-use devices and specified technologies
used for drinking-water treatment. Certification of devices is discussed elsewhere (see
section 1.2.9).
Performance targets can be applied to chemical hazards. In comparison with targets for microbial hazards, they are typically applied to specific chemicals, with performance measured in terms of percentage reduction (see section 8.4).
3.3.4 Specified technology targets
Specified technology targets typically take the form of recommendations concerning
technologies applicable in certain circumstances (e.g. filtration and disinfection of
43
specific and approved treatment processes in relation to source types and characteristics;
providing guidance on requirements for protection of well heads;
requirements for protection of drinking-water quality in distribution systems.
It is important to review specified targets on a regular basis to ensure that they are
kept up to date in terms of the prevailing scientific knowledge about the technology
and its application.
44
4
Water safety plans
Introduction
(Chapter 1)
he most effective
FRAMEWORK FOR SAFE DRINKING-WATER
SUPPORTING
INFORMATION
means of consistently ensuring the safety
Health-based targets
Public health context
Microbial aspects
(Chapter 3)
and health outcome
(Chapters 7 and 11)
of a drinking-water supChemical aspects
Water safety plans
ply is through the use
(Chapters 8 and 12)
(Chapter 4)
of a comprehensive risk
Radiological
System
Management and
Monitoring
assessment and risk
aspects
assessment
communication
(Chapter 9)
management approach
Acceptability
that encompasses all
Surveillance
aspects
(Chapter 5)
(Chapter 10)
steps in the water supply
from catchment to consumer. In these GuideApplication of the Guidelines
in specific circumstances
lines, such approaches
(Chapter 6)
are termed water safety
Climate change, Emergencies,
Rainwater harvesting, Desalination
plans (WSPs). The WSP
systems, Travellers, Planes and
ships, etc.
approach has been developed to organize and
systematize a long history of management practices applied to drinking-water and to
ensure the applicability of these practices to the management of drinking-water quality. WSPs represent an evolution of the concept of sanitary surveys and vulnerability
assessments that include and encompass the whole of the water supply system and its
operation. The WSP approach draws on many of the principles and concepts from
other risk management approaches, in particular the multiple-barrier approach and
hazard assessment and critical control points (as used in the food industry).
This chapter focuses on the key principles of WSPs and is not a comprehensive
guide to their application in practice. Practical information on how to develop and
implement a WSP is available in the supporting document Water safety plan manual
(Annex 1).
45
WSPs vary in complexity, as appropriate for the situation. In many cases, they will
be quite simple, focusing on the key hazards identified for the specific drinking-water
supply system. The wide range of examples of control measures given in the following
text does not imply that all of these are appropriate in all cases.
WSPs should, by preference, be developed for individual drinking-water systems.
For smaller systems, it may be possible to develop generic WSPs by a statutory body or
accredited third-party organization. In these settings, guidance on household water
storage, handling and use may also be required. Plans dealing with household water
should be linked to a hygiene education programme and advice to households in
maintaining water safety.
A WSP has three key componA WSP comprises, as a minimum, the three key
components that are the responsibility of the
ents, which are guided by healthdrinking-water supplier in order to ensure that
based targets (see chapter 3) and
drinking-water is safe. These are:
overseen through drinking-water
a system assessment;
supply surveillance (see chapter 5).
effective operational monitoring;
management and communication.
They are:
1) a system assessment to determine whether the drinking-water supply chain (up to the point of consumption)
as a whole can deliver water of a quality that meets identified targets. This also
includes the assessment of design criteria of new systems;
2) identifying control measures in a drinking-water system that will collectively
control identified risks and ensure that the health-based targets are met. For
each control measure identified, an appropriate means of operational monitoring
should be defined that will ensure that any deviation from required performance
is rapidly detected in a timely manner;
3) management and communication plans describing actions to be taken during normal operation or incident conditions and documenting the system assessment,
including upgrade and improvement planning, monitoring and communication
plans and supporting programmes.
The primary objectives of a WSP in ensuring good drinking-water supply practice are the prevention or minimization of contamination of source waters, the reduction or removal of contamination through treatment processes and the prevention of contamination during storage, distribution and handling of drinking-water.
These objectives are equally applicable to large piped drinking-water supplies, small
community supplies (see section 1.2.6) and household systems and are achieved
through:
undertaking verification of drinking-water quality to ensure that the WSP is being implemented correctly and is achieving the performance required to meet
relevant national, regional and local water quality standards or objectives.
WSPs are a powerful tool for the drinking-water supplier to manage the supply
safely. They also assist surveillance by public health authorities. Key benefits for water
suppliers implementing WSPs include:
Planned review
drinking-water. It must be recognized that even if other hazards are identified in the
catchment, remediation may take time, and this should not be a reason for delaying
the start of WSP preparation and implementation. Similarly, initiating the process of
ensuring that the distribution system is intact and managed appropriately is a vital
step that is under the control of the water supplier.
Many of the procedures inherent in the WSP, such as documenting the system
and ensuring that standard operating procedures are established for each of the treatment processes and the operation of the distribution system, are simply normal good
practice in drinking-water supply. The WSP should therefore build on and improve
existing practice.
WSPs should also not be seen as a competing initiative to existing programmes already being undertaken. For example, a programme that addresses non-revenue water
(e.g. leakage), although primarily addressing a water quantity issue, is also part of a
WSP. A non-revenue water programme would address issues such as intermittent supply and low water pressure, both of which are contributing factors to contamination
of drinking-water in the distribution system.
48
It is recognized that it will not be possible to fully establish a WSP all at once, but
the mapping of the system, the identification of the hazards and the assessment of the
risks will provide a framework for prioritizing actions and will identify the requirements for continuing improvement as resources become available. They will also identify and help make the case for resource allocation and investment so that they can be
targeted to provide the greatest benefit, thus optimizing resources and investment.
In some countries, the regulatory system is relatively complex. A vital component
of WSPs and the delivery of safe drinking-water is proper communication and exchange of information between regulators, including environmental authorities, and
between regulators or authorities and water suppliers. This is particularly important if
resources are to be optimized, and shared information can lead to savings on all sides,
while ensuring that drinking-water supplies are improved.
Small supplies remain a significant challenge for many countries, partly because
human, technical and financial resources are limited. The introduction of WSPs helps
to identify simple and cost-effective steps that can be taken to protect and improve
such supplies. It is important that health authorities emphasize the importance of
safe drinking-water to the local community and raise the status of the operators role
in the community. It would also be helpful for the relevant authorities to provide a
resource or point of contact where operators can obtain advice on and help for WSP
implementation.
49
groundwaters may affect the integrity of borehole casings and pumps, leading to unacceptably high levels of iron in the supply, eventual breakdown and expensive repair
work. Both the quality and availability of drinking-water may be reduced and public
health endangered.
4.1.2 Collecting and evaluating available data
Areas that should be taken into consideration as part of the assessment of the drinkingwater system include all real or potential hazards and hazardous events associated with
each step in the drinking-water system that could result in contamination or interruption of supply. In most cases, consultation with public health and other sectors, including land and water users and all those who regulate activities in the catchment, will be
required for the analysis of catchments. A structured approach is important to ensure
that significant issues are not overlooked and that areas of greatest risk are identified.
The overall assessment of the drinking-water system should take into consideration any historical water quality data that may assist in understanding source water
characteristics and drinking-water system performance both over time and following specific events (e.g. heavy rainfall). For examples of information to consider in
assessing components of the drinking-water system, see Module 3 in the supporting
document Water safety plan manual (Annex 1).
Prioritizing hazards for control
Once potential hazards and their sources have been identified, the risk associated with
each hazard or hazardous event should be compared so that priorities for risk management can be established and documented. Although there are numerous contaminants that can compromise drinking-water quality, not every hazard or hazardous
event will require the same degree of attention.
The risk associated with each hazard or hazardous event may be described by
identifying the likelihood of occurrence (e.g. certain, possible, rare) and evaluating the
severity of consequences if the hazard occurred (e.g. insignificant, major, catastrophic).
The aim should be to distinguish between important and less important hazards or
hazardous events. The approach used typically involves a semiquantitative matrix.
Simple scoring matrices often apply technical information from guidelines, scientific literature and industry practice with well-informed expert judgement based
on knowledge and experience of WSP team members, supported by peer review or
benchmarking. Scoring is specific for each drinking-water system, as each system is
unique. Where generic WSPs are developed for technologies used by small drinkingwater systems, the scoring will be specific to the technology rather than the individual
drinking-water system.
By using risk ranking, control measures can be prioritized in relation to their
significance. A variety of semiquantitative and qualitative approaches to ranking risk
can be applied, and Module 3 of the supporting document Water safety plan manual
(Annex 1) provides a series of practice-based examples. An example of a semiquantitative approach is given in Table 4.1. Application of this matrix relies to a significant
extent on expert opinion to make judgements on the public health risk posed by hazards or hazardous events.
51
Insignificant
Minor
Moderate
Major
Catastrophic
Almost certain
10
15
20
25
Likely
12
16
20
Moderately likely
12
15
Unlikely
10
Rare
Risk score
Risk rating
<6
Low
69
Medium
1015
High
> 15
Very high
Table 4.2 Examples of definitions of likelihood and severity categories that can be used in risk
scoring
Item
Rating
Definition
Likelihood categories
Almost certain
Likely
Moderately likely
Unlikely
Rare
Severity categories
Catastrophic
Major
Regulatory impact
Moderate
Aesthetic impact
Minor
Compliance impact
Insignificant
monitoring and frequency of data collection based on the nature of the control
measure and the rapidity with which change may occur (see section 4.2).
4.1.3 Resource and source protection
Effective catchment management has many benefits. By decreasing the contamination
of the source water, the amount of treatment required is reduced. This may reduce the
production of treatment by-products and minimize operational costs.
Hazard identification
Understanding the reasons for variations in raw water quality is important, as it will
influence the requirements for treatment, treatment efficiency and the resulting health
risk associated with the finished drinking-water. In general, raw water quality is influenced by both natural and human use factors. Important natural factors include wildlife, climate, topography, geology and vegetation. Human use factors include point
sources (e.g. wastewater discharges) and non-point sources (e.g. surface runoff). For
example, discharges of municipal wastewater can be a major source of pathogens;
urban runoff and livestock can contribute substantial microbial load; body contact
recreation can be a source of faecal contamination; and agricultural runoff, including
agrochemicals and manure, can lead to increased challenges to treatment.
Whether water is drawn from surface or underground sources, it is important that
the characteristics of the local catchment or aquifer are understood and that the scenarios that could lead to water pollution are identified and managed. The extent to which
potentially polluting activities in the catchment can be reduced may appear to be limited
by competition for water and pressure for increased development in the catchment. However, introducing good practices in land use and in containment of hazards is often possible without substantially restricting activities, and collaboration between stakeholders
may be a powerful tool to reduce pollution without reducing beneficial development.
53
Resource and source protection provides the first barrier in protection of drinkingwater quality. Where catchment management is beyond the jurisdiction of the drinking-water supplier, the planning and implementation of control measures will require
coordination with other agencies. These may include planning authorities, catchment
boards, environmental and water resource regulators, road authorities, emergency services and agricultural, industrial and other commercial entities whose activities have
an impact on water quality. It may not be possible to apply all aspects of resource
and source protection initially; nevertheless, priority should be given to catchment
management. This will contribute to a sense of ownership and joint responsibility for
drinking-water resources through multistakeholder bodies that assess pollution risks
and develop plans for improving management practices for reducing these risks.
Groundwater from deep and confined aquifers is usually microbially safe and
chemically stable in the absence of direct contamination; however, shallow or unconfined aquifers can be subject to contamination from discharges or seepages associated
with agricultural practices (e.g. pathogens, nitrates and pesticides), on-site sanitation
and sewerage (e.g. pathogens and nitrates) and industrial wastes. For examples of hazards and hazardous situations that should be taken into consideration as part of a hazard
analysis and risk assessment, see Module 4 in the supporting document Water safety plan
manual and the supporting document Protecting groundwater for health (Annex 1).
Control measures
Effective resource and source protection includes the following elements:
Where a number of water sources are available, there may be flexibility in the selection of water for treatment and supply. It may be possible to avoid taking water from
rivers and streams when water quality is poor (e.g. following heavy rainfall) in order to
reduce risk and prevent potential problems in subsequent treatment processes.
Retention of water in reservoirs can reduce the number of faecal microorganisms through settling and inactivation, including solar (ultraviolet) disinfection, but
also provides opportunities for the introduction of contamination. Most pathogenic
microorganisms of faecal origin (enteric pathogens) do not survive indefinitely in the
environment. Substantial die-off of enteric bacteria will occur over a period of weeks.
Enteric viruses and protozoa will often survive for longer periods (weeks to months)
but are often removed by settling and antagonism from indigenous microbes. Retention also allows suspended material to settle, which makes subsequent disinfection
more effective and reduces the formation of disinfection by-products (DBPs).
Control measures for groundwater sources should include protecting the aquifer
and the local area around the borehead from contamination and ensuring the physical
54
integrity of the bore (surface sealed, casing intact, etc.); further information can be
found in the supporting document Protecting groundwater for health (Annex 1).
For examples of control measures for effective protection of source water and
catchments and of water extraction and storage systems, see Module 4 in the supporting document Water safety plan manual (Annex 1). Further information on the
use of indicator organisms in catchment characterization is also available in chapter 4
of the supporting document Assessing microbial safety of drinking water (Annex 1).
4.1.4 Treatment
After source water protection, the next barriers to contamination of the drinkingwater system are those of water treatment processes, including disinfection and
physical removal of contaminants.
Hazard identification
Hazards may be introduced during treatment, or hazardous events may allow contaminants to pass through treatment in significant concentrations. Constituents of
drinking-water can be introduced through the treatment process, including chemical
additives used in the treatment process or products in contact with drinking-water.
Sporadic high turbidity in source water can overwhelm treatment processes, allowing
enteric pathogens into treated water and the distribution system. Similarly, suboptimal
filtration following filter backwashing can lead to the introduction of pathogens into
the distribution system.
For examples of potential hazards and hazardous events that can have an impact on the performance of drinking-water treatment, see Module 3 in the supporting
document Water safety plan manual (Annex 1).
Control measures
Control measures may include pretreatment, coagulation, flocculation, sedimentation,
filtration and disinfection.
Pretreatment includes processes such as roughing filters, microstrainers, offstream storage and bankside filtration. Pretreatment options may be compatible with
a variety of treatment processes ranging in complexity from simple disinfection to
membrane processes. Pretreatment can reduce or stabilize the microbial, natural
organic matter and particulate load.
Coagulation, flocculation, sedimentation (or flotation) and filtration remove particles, including microorganisms (bacteria, viruses and protozoa). It is important that
processes are optimized and controlled to achieve consistent and reliable performance.
Chemical coagulation is the most important step in determining the removal efficiency of coagulation, flocculation and clarification processes. It also directly affects
the removal efficiency of granular media filtration units and has indirect impacts on
the efficiency of the disinfection process. While it is unlikely that the coagulation process itself introduces any new microbial hazards to finished water, a failure or inefficiency in the coagulation process could result in an increased microbial load entering
drinking-water distribution.
Various filtration processes are used in drinking-water treatment, including granular, slow sand, precoat and membrane (microfiltration, ultrafiltration, nanofiltration
55
and reverse osmosis) filtration. With proper design and operation, filtration can act
as a consistent and effective barrier for pathogenic microorganisms and may in some
cases be the only treatment barrier (e.g. for removing Cryptosporidium oocysts by
direct filtration when chlorine is used as the sole disinfectant).
Application of an adequate concentration of disinfectant is an essential element
for most treatment systems to achieve the necessary level of microbial risk reduction.
Taking account of the level of microbial inactivation required for the more resistant
microbial pathogens through the application of the Ct concept (product of disinfectant concentration and contact time) for a particular pH and temperature ensures that
other, more sensitive microbes are also effectively controlled. Where disinfection is
used, measures to minimize DBP formation should be taken into consideration.
The most commonly used disinfection process is chlorination. Ozonation, ultraviolet irradiation, chloramination and application of chlorine dioxide are also used.
These methods are very effective in killing bacteria and can be reasonably effective
in inactivating viruses (depending on type), and some may inactivate many protozoa, including Giardia and Cryptosporidium. For effective removal or inactivation of
protozoal cysts and oocysts, filtration with the aid of coagulation and flocculation (to
reduce particles and turbidity) followed by disinfection (by one or a combination of
disinfectants) is the most practical method.
Storage of water after disinfection and before supply to consumers can improve disinfection by increasing disinfectant contact times. This can be particularly
important for more resistant microorganisms, such as Giardia and some viruses.
For examples of treatment control measures, see Module 4 in the supporting
document Water safety plan manual (Annex 1). Further information can also be found
in the supporting document Water treatment and pathogen control (Annex 1).
4.1.5 Piped distribution systems
Water treatment should be optimized to prevent microbial growth, corrosion of pipe
materials and the formation of deposits.
Maintaining good water quality in the distribution system will depend on the design and operation of the system and on maintenance and survey procedures to prevent
contamination and to prevent and remove the accumulation of internal deposits.
Hazard identification
The protection of the distribution system is essential for providing safe drinking-water.
Because of the nature of the distribution system, which may include many kilometres
of pipe, storage tanks, interconnections with industrial users and the potential for
tampering and vandalism, opportunities for microbial and chemical contamination
exist. For examples of hazards and hazardous events in piped distribution systems, see
Module 3 in the supporting document Water safety plan manual (Annex 1).
When contamination by enteric pathogens or hazardous chemicals occurs within
the distribution system, it is likely that consumers will be exposed to the pathogens
or chemicals. In the case of pathogen ingress, even where disinfectant residuals are
employed to limit microbial occurrence, they may be inadequate to overcome the contamination or may be ineffective against some or all of the pathogen types introduced.
56
As a result, pathogens may occur in concentrations that could lead to infection and
illness.
Where water is supplied intermittently, the resulting low water pressure will allow
the ingress of contaminated water into the system through breaks, cracks, joints and
pinholes. Intermittent supplies are not desirable but are very common in many countries and are frequently associated with contamination. The control of water quality
in intermittent supplies represents a significant challenge, as the risks of infiltration
and backflow increase significantly. The risks may be elevated seasonally as soil moisture conditions increase the likelihood of a pressure gradient developing from the
soil to the pipe. Where contaminants enter the pipes in an intermittent supply, the
charging of the system when supply is restored may increase risks to consumers, as a
concentrated slug of contaminated water can be expected to flow through the system. Where household storage is used to overcome intermittent supply, localized use
of disinfectants to reduce microbial proliferation may be warranted.
Drinking-water entering the distribution system may contain free-living amoebae and environmental strains of various heterotrophic bacterial and fungal species.
Under favourable conditions, amoebae and heterotrophs, including strains of Citrobacter, Enterobacter and Klebsiella, may colonize distribution systems and form biofilms. There is no evidence to implicate the occurrence of most microorganisms from
biofilms (one exception is Legionella, which can colonize water systems in buildings)
with adverse health effects in the general population through drinking-water, with
the possible exception of severely immunocompromised people (see the supporting
document Heterotrophic plate counts and drinking-water safety; Annex 1).
Water temperatures and nutrient concentrations are not generally elevated
enough within the distribution system to support the growth of E. coli (or enteric
pathogenic bacteria) in biofilms. Thus, the presence of E. coli should be considered as
evidence of recent faecal contamination.
Natural disasters, including flood, drought and earth tremors, may significantly
affect piped water distribution systems.
Control measures
Water entering the distribution system must be microbially safe and ideally should
also be biologically stable. The distribution system itself must provide a secure barrier to contamination as the water is transported to the user. Maintaining a disinfectant residual throughout the distribution system can provide some protection against
recontamination and limit microbial growth problems. Chloramination has proved
successful in controlling Naegleria fowleri in water and sediments in long pipelines
and may reduce the regrowth of Legionella within buildings.
Residual disinfectant will provide partial protection against microbial contamination, but it may also mask the detection of contamination through the use of
conventional faecal indicator bacteria such as E. coli, particularly by resistant organisms. Where a disinfectant residual is used within a distribution system, measures to
minimize DBP production should be taken into consideration.
Water distribution systems should be fully enclosed, and storage reservoirs and
tanks should be securely roofed with external drainage to prevent contamination.
57
Control of short-circuiting and prevention of stagnation in both storage and distribution contribute to prevention of microbial growth. A number of strategies can be
adopted to maintain the quality of water within the distribution system, including use
of backflow prevention devices, maintaining positive pressure throughout the system
and implementation of efficient maintenance procedures. It is also important that
appropriate security measures be put in place to prevent unauthorized access to or
interference with the drinking-water system infrastructure.
Control measures may include using a more stable secondary disinfecting chemical (e.g. chloramines instead of free chlorine), undertaking a programme of pipe replacement, flushing and relining and maintaining positive pressure in the distribution
system. Reducing the time that water is in the system by avoiding stagnation in storage
tanks, loops and dead-end sections will also contribute to maintaining drinking-water
quality. For other examples of distribution system control measures, see Module 4 in
the supporting document Water safety plan manual (Annex 1). Further information is
also available in the supporting document Safe piped water (Annex 1).
4.1.6 Non-piped, community and household systems
Hazard identification
For non-piped, community and household drinking-water systems, hazard identification would ideally be performed on a case-by-case basis. In practice, however, reliance
is typically placed on general assumptions of hazardous conditions that are relevant
for technologies or system types and that may be defined at a national or regional
level.
For examples of hazards and hazardous situations potentially associated with
various non-piped sources of water, see Module 3 in the supporting document Water
safety plan manual (Annex 1). Further guidance is also provided in the supporting
document Water safety plans (Annex 1) and in the 1997 volume entitled Surveillance
and control of community supplies (WHO, 1997).
Control measures
The control measures required ideally depend on the characteristics of the source
water and the associated catchment; in practice, standard approaches may be applied
for each of these, rather than customized assessment of each system.
For examples of control measures for various non-piped sources, see Module 4
in the supporting document Water safety plan manual (Annex 1) and the 1997 report
entitled Surveillance and control of community supplies (WHO, 1997).
In most cases, contamination of groundwater supplies can be controlled by a
combination of simple measures. In the absence of fractures or fissures, which may
allow rapid transport of contaminants to the source, groundwater in confined or deep
aquifers will generally be free of pathogenic microorganisms. Bores should be encased
to a reasonable depth, and boreheads should be sealed to prevent ingress of surface
water or shallow groundwater.
Rainwater harvesting systems, particularly those involving storage in aboveground
tanks, can be a relatively safe supply of water (see section 6.2). The principal sources
of contamination are birds, small mammals and debris collected on roofs. The impact
58
Guidance is available regarding how water safety may be ensured for household
water collection, transport and storage (see the supporting document Managing water
in the home; Annex 1). This should be used in conjunction with hygiene education
programmes to support health promotion in order to reduce water-related disease.
4.1.7 Validation
For the WSP to be relied on for anticipating and managing the hazards and hazardous events for which it was set in place, it needs to be supported by accurate and
reliable technical information. Validation is concerned with obtaining evidence on
the performance of control measures. Depending on the type of control, validation
can be done by site inspection, using existing data and literature or targeted
59
60
be needed. The assessment of the system should be used as a basis to develop a plan to
address identified needs for full implementation of a WSP.
Improvement of the drinking-water system may encompass a wide range of
issues, such as:
capital works;
training;
enhanced operational procedures;
community consultation programmes;
research and development;
developing incident protocols;
communication and reporting.
Upgrade and improvement plans can include short-term (e.g. 1 year) or longterm programmes. Short-term improvements might include, for example, improvements to community consultation and the development of community awareness
programmes. Long-term capital works projects could include covering of water
storage containers or enhanced coagulation and filtration.
Implementation of improvement plans may have significant budgetary implications and therefore may require detailed analysis and careful prioritization in accord
with the outcomes of risk assessment. Implementation of plans should be monitored
to confirm that improvements have been made and are effective. Control measures
often require considerable expenditure, and decisions about water quality improvements cannot be made in isolation from other aspects of drinking-water supply that
compete for limited financial resources. Priorities will need to be established, and
improvements may need to be phased in over a period of time.
operational monitoring parameters that can be measured and for which limits
can be set to define the operational effectiveness of the activity;
operational monitoring parameters that can be monitored with sufficient
frequency to reveal failures in a timely fashion;
61
For source waters, these include turbidity, ultraviolet absorbency, algal growth,
flow and retention time, colour, conductivity, local meteorological events and integrity of protective (e.g. fences) or abstraction infrastructures (e.g. well seals)
(see the supporting document Protecting groundwater for health; Annex 1).
For treatment, parameters may include disinfectant concentration and contact
time, ultraviolet intensity, pH, light absorbency, membrane integrity, turbidity
and colour (see the supporting document Water treatment and pathogen control;
Annex 1).
In piped distribution systems, operational monitoring parameters may include
the following:
Chlorine residual monitoring provides a rapid indication of problems that will
direct measurement of microbial parameters. A sudden disappearance of an
otherwise stable residual can indicate ingress of contamination. Alternatively,
difficulties in maintaining residuals at points in a distribution system or a
gradual disappearance of residual may indicate that the water or pipework
has a high oxidant demand due to growth of bacteria.
Oxidationreduction potential (or redox potential) measurement can also be
used in the operational monitoring of disinfection efficacy. It is possible to
define a minimum level of oxidationreduction potential necessary to ensure
effective disinfection. This value has to be determined on a case-by-case basis;
universal values cannot be recommended. Further research and evaluation of
oxidationreduction potential as an operational monitoring technique are
highly desirable.
Heterotrophic bacteria present in a supply can be a useful indicator of
changes, such as increased microbial growth potential, increased biofilm
activity, extended retention times or stagnation and a breakdown of integrity
of the system. The numbers of heterotrophic bacteria present in a supply may
62
reflect the presence of large contact surfaces within the treatment system,
such as in-line filters, and may not be a direct indicator of the condition
within the distribution system (see the supporting document Heterotrophic
plate counts and drinking-water safety; Annex 1).
Pressure measurement and turbidity are also useful operational monitoring
parameters in piped distribution systems.
Guidance for management of distribution system operation and maintenance
is available (see the supporting document Safe piped water; Annex 1) and includes
the development of a monitoring programme for water quality and other parameters
such as pressure.
Examples of operational monitoring parameters are provided in Table 4.3.
4.2.3 Establishing operational and critical limits
Control measures need to have defined limits for operational acceptabilitytermed
operational limitsthat can be applied to operational monitoring parameters. Operational limits should be defined for parameters applying to each control measure. If
monitoring shows that an operational limit has been exceeded, then predetermined
corrective actions (see section 4.4) need to be applied. The detection of the deviation
and implementation of corrective action should be possible in a time frame adequate
to maintain performance and water safety.
For some control measures, a second series of critical limits may also be defined,
outside of which confidence in water safety would be lost. Deviations from critical
limits will usually require urgent action, including immediate notification of the appropriate health authority.
Operational and critical limits can be upper limits, lower limits, a range or an
envelope of performance measures.
4.2.4 Non-piped, community and household systems
Generally, surface water or shallow groundwater should not be used as a source of
drinking-water without sanitary protection or treatment.
Monitoring of water sources (including rainwater tanks) by community operators or households will typically involve periodic sanitary inspection (for details, see
the 1997 volume entitled Surveillance and control of community supplies; WHO, 1997).
The sanitary inspection forms used should be comprehensible and easy to use; for
instance, the forms may be pictorial. The risk factors included should be preferably
related to activities that are under the control of the operator and that may affect water
quality. The links to action from the results of operational monitoring should be clear,
and training will be required.
Operators should also undertake regular physical assessments of the water, especially after heavy rains, to monitor whether any obvious changes in water quality have
occurred (e.g. changes in colour, odour, taste or turbidity).
Maintaining the quality of water during collection and manual transport is the responsibility of the household. Good hygiene practices are required and should be supported through hygiene education. Hygiene education programmes should provide
households and communities with skills to monitor and manage their water hygiene.
63
Dissolved oxygen
Stream/river flow
Rainfall
Colour
Organic carbon
Filtration
9
9
Distribution
system
Disinfection
pH
Sedimentation
Operational parameter
Coagulation
Raw water
Table 4.3 Examples of operational monitoring parameters that can be used to monitor control
measures
9
9
Chemical dosage
Flow rate
Net charge
Headloss
Ct (disinfectant concentration contact time)
Disinfectant residual
Oxidationreduction potential
DBPs
Heterotrophic bacteria
Hydraulic pressure
4.3 Verification
Verification provides a final check on the overall performance of the drinking-water
supply chain and the safety of drinking-water being supplied to consumers. Verification
should be undertaken by the surveillance agency; water suppliers may also undertake
internal verification programmes.
64
For microbial verification, testing is typically for faecal indicator bacteria in treated water and water in distribution. For verification of chemical safety, testing for
chemicals of concern may
be at the end of treatment,
In addition to operational monitoring of the performance of
in distribution or at the
the individual components of a drinking-water system, it is
necessary to undertake final verification for reassurance that
point of consumption
the system as a whole is operating safely. Verification may
(depending on whether
be undertaken by the supplier, by an independent authority
the concentrations are
or by a combination of these, depending on the administralikely to change in distritive regime in a given country. It typically includes testing for
faecal indicator organisms and hazardous chemicals, as well
bution). Trihalomethanes
as auditing that WSPs are being implemented as intended
and haloacetic acids are
and are working effectively.
the most common DBPs
and occur at among the
highest concentrations in drinking-water. Under many circumstances, they can serve
as a suitable measure that will reflect the concentration of a wide range of related
chlorinated DBPs.
Frequencies of sampling should reflect the need to balance the benefits and costs of
obtaining more information. Sampling frequencies are usually based on the population
served or on the volume of water supplied, to reflect the increased population risk.
Frequency of testing for individual characteristics will also depend on variability. Sampling and analysis are required most frequently for microbial and less often for chemical constituents. This is because even brief episodes of microbial contamination can
lead directly to illness in consumers, whereas episodes of chemical contamination that
would constitute an acute health concern, in the absence of a specific event (e.g. chemical overdosing at a treatment plant), are rare. Sampling frequencies for water leaving
treatment depend on the quality of the water source and the type of treatment.
Plans should be developed to respond to results that do not meet water quality
targets. These should include investigation of the cause of non-compliance and, where
necessary, corrective action, such as boil water advisories. Repeated failure to meet
targets should lead to review of the WSP and development of improvement plans.
4.3.1 Microbial water quality
Verification of the microbial quality of drinking-water typically includes testing for
Escherichia coli as an indicator of faecal pollution. In practice, testing for thermotolerant coliform bacteria can be an acceptable alternative in many circumstances.
Although E. coli is useful, it has limitations. Enteric viruses and protozoa are more
resistant to disinfection; consequently, the absence of E. coli will not necessarily indicate freedom from these organisms. Under certain circumstances, the inclusion of
more resistant indicators, such as bacteriophages and/or bacterial spores, should be
considered (see section 7.4).
Verification of the microbial quality of water in supply must be designed
to ensure the best possible chance of detecting contamination. Sampling should
therefore account for potential variations of water quality in distribution. This will
normally mean taking account of locations and of times of increased likelihood of
contamination.
65
66
Table 4.4 Recommended minimum sample numbers for faecal indicator testing in distribution
systemsa
Type of water supply
and population
Point sources
Piped supplies
< 5000
12
5000100 000
Parameters such as chlorine, turbidity and pH should be tested more frequently as part of operational and verification
monitoring.
on a regular basis (the frequency of verification testing will depend on several factors, including the size of the community supplied, the reliability of the quality of
the drinking-water or degree of treatment and the presence of local risk factors);
on an occasional basis (e.g. random or during visits to community-managed
drinking-water supplies);
increased following degradation of source water quality resulting from predictable
incidents, emergencies or unplanned events considered likely to increase the potential for a breakthrough in contamination (e.g. following a flood, upstream spills).
from piping and plumbing materials and that are not controlled through their direct
regulation and for constituents whose concentrations change in distribution, such as
trihalomethanes. The use of stratified random sampling in distribution systems has
proven to be effective.
4.3.5 Community-managed supplies
If the performance of a community drinking-water system is to be properly evaluated, a number of factors must be considered. Some countries that have developed
national strategies for the surveillance and quality control of drinking-water systems
have adopted quantitative service indicators (i.e. quality, quantity, accessibility, coverage, affordability and continuity) for application at community, regional and national
levels. Usual practice would be to include the critical parameters for microbial quality (normally E. coli, chlorine, turbidity and pH) and for a sanitary inspection to be
carried out. Methods for these tests must be standardized and approved. It is recommended that field test kits be validated for performance against reference or standard
methods and approved for use in verification testing.
Together, service indicators provide a basis for setting targets for community
drinking-water supplies. They serve as a quantitative guide to the adequacy of drinking-water supplies and provide consumers with an objective measure of the quality of
the overall service and thus the degree of public health protection afforded.
Periodic testing and sanitary inspection of community drinking-water supplies
should typically be undertaken by the surveillance agency and should assess microbial hazards and known problem chemicals (see also chapter 5). Frequent sampling is
unlikely to be possible, and one approach is therefore a rolling programme of visits
to ensure that each supply is visited once every 35 years. The primary purpose is
to inform strategic planning and policy rather than to assess compliance of individual drinking-water supplies. Comprehensive analysis of the chemical quality of all
sources is recommended prior to commissioning as a minimum and preferably every
35 years thereafter.
Advice on the design of sampling programmes and on the frequency of sampling for community supplies is given in the 1997 volume, Surveillance and control of
community supplies (WHO, 1997).
4.3.6 Quality assurance and quality control
Appropriate quality assurance and analytical quality control procedures should be
implemented for all activities linked to the production of drinking-water quality data.
These procedures will ensure that the data are fit for purposein other words, that
the results produced are of adequate accuracy. Fit for purpose, or adequate accuracy, will be defined in the water quality monitoring programme, which will include
a statement about accuracy and precision of the data. Because of the wide range of
substances, methods, equipment and accuracy requirements likely to be involved in
the monitoring of drinking-water, many detailed, practical aspects of analytical quality control are concerned. These are beyond the scope of this publication.
The design and implementation of a quality assurance programme for analytical
laboratories are described in detail in Water quality monitoring: A practical guide to the
68
design and implementation of freshwater quality studies and monitoring programmes (Bartram & Ballance, 1996). The relevant chapter relates to standard ISO/IEC 17025:2005,
General requirements for the competence of testing and calibration laboratories, which
provides a framework for the management of quality in analytical laboratories.
Guidance on sampling is given in the International Organization for
Standardization (ISO) standards listed in Table 4.5.
4.3.7 Water safety plans
In addition to testing of water quality, verification should include audits of WSPs
to demonstrate that the plans have been properly designed, are being implemented
correctly and are effective. Factors to consider include the following:
Audits can be undertaken as part of internal or external reviews and may form
part of surveillance by independent authorities. Auditing can have both an assessment
and a compliance-checking function.
Table 4.5 International Organization for Standardization (ISO) standards for water quality
giving guidance on samplinga
ISO standard no. Title (water quality)
5667-1:2006
5667-3:2003
5667-4:1987
5667-5:2006
5667-6:2005
5667-11:2009
5667-13:1997
5667-14:1998
5667-16:1998
5667-20:2008
5667-21:2010
5667-23:2011
5668-17:2008
13530:2009
17381:2003
ISO has also established quality management standards relating to drinking-water supply, including ISO 24510:2007,
Activities relating to drinking water and wastewater servicesGuidelines for the assessment and for the improvement
of the service to users; and ISO 24512:2007, Activities relating to drinking water and wastewater servicesGuidelines
for the management of drinking water utilities and for the assessment of drinking water services.
accountabilities and contact details for key personnel, often including several
organizations and individuals;
lists of measurable indicators and limit values/conditions that would trigger
incidents, along with a scale of alert levels;
clear description of the actions required in response to alerts;
location and identity of the standard operating procedures and required
equipment;
location of backup equipment;
relevant logistical and technical information;
checklists and quick reference guides.
70
The plan may need to be followed at very short notice, so standby rosters, effective
communication systems and up-to-date training and documentation are required.
Staff should be trained in response procedures to ensure that they can manage
incidents or emergencies effectively. Incident and emergency response plans should
be periodically reviewed and practised. This improves preparedness and provides
opportunities to improve the effectiveness of plans before an emergency occurs.
Following any incident or emergency, an investigation should be undertaken
involving all concerned staff. The investigation should consider factors such as:
71
Response plans for emergencies and unforeseen events involving microorganisms or chemicals should also include the basis for issuing boil water advisories (see
section 7.6.1) and water avoidance advisories (see section 8.7.10). The objective of
the advisory should be taken in the public interest. Therefore, the advisory should be
issued after rapid, but careful, consideration of available information and conclusion
that there is an ongoing risk to public health that outweighs any risk from the advice
to boil or avoid water. The advisory will typically be managed by public health authorities. A decision to close a drinking-water supply carries an obligation to provide
an alternative safe supply and is very rarely justifiable because of the adverse effects,
especially to health, of restricting access to water. Specific actions in the event of a
guideline exceedance or an emergency are discussed in section 7.6 (microbial hazards)
and section 8.7 (chemical hazards); more general considerations are discussed in section 6.7. Practice emergencies are an important part of the maintenance of readiness
for emergencies. They help to determine the potential actions that can be taken in
different circumstances for a specific water supply.
72
parameters to be monitored;
sampling location and frequency;
sampling methods and equipment;
schedules for sampling;
references to corrective action procedures, including responsibilities;
qualifications and certification requirements for testing laboratories;
methods for quality assurance and validation of sampling results;
requirements for checking and interpreting results;
responsibilities and necessary qualifications of staff;
requirements for documentation and management of records, including how
monitoring results will be recorded and stored;
requirements for reporting and communication of results.
controlling access to treatment plants, catchments and reservoirs and implementing the
Actions that are important in
ensuring drinking-water safety
appropriate security measures to prevent
but do not directly affect drinktransfer of hazards from people when they do
ing-water quality are referred
enter source water;
to as supporting programmes.
developing verification protocols for the use of
chemicals and materials in the drinking-water
supplyfor instance, to ensure the use of suppliers that participate in quality assurance programmes;
using designated equipment for attending to incidents such as mains bursts
(e.g. equipment should be designated for potable water work only and not for
sewage work);
training and educational programmes for personnel involved in activities that
could influence drinking-water safety; training should be implemented as part of
induction programmes and frequently updated;
research and development to improve understanding of water quality, including
the quality of source waters, and treatment.
Codes of good operating and management practice and hygienic working practice are essential elements of supporting programmes. These are often captured within
standard operating procedures. They include, but are not limited to:
Comparison of one set of supporting programmes with the supporting programmes of other suppliers, through peer review, benchmarking and personnel or
document exchange, can stimulate ideas for improved practice.
Supporting programmes can be extensive, be varied and involve multiple organizations and individuals. Many supporting programmes involve water resource
protection measures and typically include aspects of land use control. Some water
resource protection measures are engineered, such as effluent treatment processes and
stormwater management practices that may be used as control measures.
developing programmes to upgrade and improve existing water delivery (usually defined at a national or regional level rather than at the level of individual
supplies) (see section 4.1.8).
For small point sources serving communities or individual households, the emphasis should be on selecting source water of the best available quality and on protecting its quality by the use of multiple barriers (usually within source protection)
and maintenance programmes. Whatever the source (groundwater, surface water or
rainwater tanks), communities and householders should assure themselves that the
water is safe to drink. Generally, surface water and shallow groundwater under the direct influence of surface water (which includes shallow groundwater with preferential
flow paths) should receive treatment.
The parameters recommended for the minimum monitoring of community supplies are those that best establish the hygienic state of the water and thus the risk of
waterborne disease. The essential parameters of water quality are E. colithermotolerant (faecal) coliforms are accepted as suitable substitutesand chlorine residual (if
chlorination is practised). These should be supplemented, where appropriate, by pH
adjustment (if chlorination is practised) and measurement of turbidity.
These parameters may be measured on site using relatively unsophisticated testing
equipment, and improved and relatively low cost systems continue to be developed.
On-site testing is essential for the determination of turbidity and chlorine residual,
which change rapidly during transport and storage; it is also important for the other
parameters where laboratory support is lacking or where transportation problems
would render conventional sampling and analysis impractical.
Other health-related parameters of local significance should also be measured.
The overall approach to control of chemical contamination is outlined in chapter 8.
description and assessment of the drinking-water system (see section 4.1), including programmes to upgrade and improve existing water delivery (see
section 4.1.8);
the plan for operational monitoring and verification of the drinking-water system
(see sections 4.2 and 4.3);
water safety management procedures for normal operation, incidents (specific
and general) and emergency situations (see sections 4.4.1, 4.4.2 and 4.4.3),
including communication plans; and
description of supporting programmes (see section 4.4.5).
Records are essential to review the adequacy of the WSP and to demonstrate
the adherence of the drinking-water system to the WSP. Several types of records are
generally kept:
procedures for promptly advising of any significant incidents within the drinkingwater supply, including notification of the public health authority;
summary information to be made available to consumersfor example, through
annual reports and on the Internet;
establishment of mechanisms to receive and actively address community
complaints in a timely fashion.
5
Surveillance
Introduction
(Chapter 1)
77
is little to be gained from surveillance of piped water supplies alone if these are available to only a small proportion of the population or if they represent a minority of
supplies.
Information alone does not lead to improvement. Instead, the effective management and use of the information generated by surveillance make possible the rational
improvement of water supplieswhere rational implies that available resources are
used for maximum public health benefit.
Surveillance is an important element in the development of strategies for incremental improvement of the quality of drinking-water supply services. It is important
that strategies be developed for implementing surveillance, collating, analysing and
summarizing data and reporting and disseminating the findings and that the strategies are accompanied by recommendations for remedial action. Follow-up will be
required to ensure that remedial action is taken.
Surveillance extends beyond drinking-water supplies operated by a discrete
drinking-water supplier to include drinking-water supplies that are managed by communities and includes assurance of good hygiene in the collection and storage of
household water.
The surveillance agency must have, or have access to, legal expertise in addition
to expertise on drinking-water and water quality. Drinking-water supply surveillance
is also used to ensure that any transgressions that may occur are appropriately investigated and resolved. In many cases, it will be more appropriate to use surveillance as a
mechanism for collaboration between public health agencies and drinking-water suppliers to improve drinking-water supply than to resort to enforcement, particularly
where the problem lies mainly with community-managed drinking-water supplies.
The authorities responsible for drinking-water supply surveillance may be the
public health ministry or other agency (see section 1.2.1), and their roles encompass
four areas of activity:
1) public health oversight of organized drinking-water supplies;
2) public health oversight and information support to populations without access to
organized drinking-water supplies, including communities and households;
3) consolidation of information from diverse sources to enable understanding of
the overall drinking-water supply situation for a country or region as a whole
as an input to the development of coherent public healthcentred policies and
practices;
4) participation in the investigation, reporting and compilation of outbreaks of
waterborne disease.
A drinking-water supply surveillance programme should normally include processes for approval of water safety plans (WSPs). This approval will normally involve
review of the system assessment, of the identification of appropriate control measures
and supporting programmes and of operational monitoring and management plans.
It should ensure that the WSP covers normal operating conditions and predictable incidents (deviations) and has contingency plans in case of an emergency or unplanned
event.
78
5. SURVEILLANCE
The surveillance agency may also support or undertake the development of WSPs
for community-managed drinking-water supplies and household water treatment
and storage. Such plans may be generic for particular technologies rather than specific
for individual systems.
79
assessment of supporting programmes and of strategies for improving and updating the WSP;
in some circumstances, sanitary inspection, which may cover the whole of the
drinking-water system, including sources, transmission infrastructure, treatment
plants, storage reservoirs and distribution systems.
In response to reports of significant incidents, it is necessary to ensure that:
specified approaches to large municipality/small municipality/community supplies and individual household supplies;
sanitary inspections to be carried out by qualified personnel;
sampling to be carried out by qualified personnel;
tests to be conducted using suitable methods by accredited laboratories or using
approved field testing equipment and qualified personnel;
procedures on reporting findings and follow-up to ensure that they have been
acted on.
5. SURVEILLANCE
in small towns by small-scale private sector operators or local government. Direct assessment may lead to the identification of requirements to amend or update the WSP,
and the process to be followed when undertaking such amendments should be clearly
identified.
Where direct assessment is carried out by the surveillance agency, it complements other verification testing of the water supplier. General guidance on verification
testing, which is also applicable to surveillance through direct assessment, is provided
in section 4.3.
limited capacity and skills within the community to undertake process control
and verification; this may increase the need both for surveillance to assess the
state of drinking-water supplies and for surveillance staff to provide training and
support to community members;
81
the very large number of widely dispersed supplies, which significantly increases
overall costs in undertaking surveillance activities.
82
5. SURVEILLANCE
ities for drinking-water supplies using household treatment and household storage
containers are therefore recommended.
The principal focus of surveillance of household-based interventions will be assessment of their acceptance and impact through sample surveys so as to evaluate
and inform overall strategy development and refinement. Systematic determination
of continued, correct and effective use and management is recommended so that
deficiencies in use and management can be identified and corrected by those responsible.
Quality: whether the supply has regularly verified water quality and an approved
WSP (see chapter 4) that has been validated and is subject to periodic audit to
demonstrate compliance with relevant regulations (see chapters 3 and 4);
Quantity (service level): the proportion of the population with access to different
levels of drinking-water supply (e.g. no access, basic access, intermediate access
and optimal access) as a surrogate for health impacts in relation to quantity of
water used;
Accessibility: the percentage of the population that has reasonable access to an
improved drinking-water supply;
Affordability: the tariff paid by domestic consumers;
Continuity: the percentage of the time during which drinking-water is available
(daily, weekly and seasonally).
Distance/time
No access
Very high
Hygiene practice
compromised
Basic consumption
may be
compromised
Very high
Provision of basic level
of service
Hygiene education
Household water
treatment and safe
storage as interim
measure
Basic access
Within 1 km /
within 30 min
round-trip
Approximately
20 litres per
capita per day on
average
High
Hygiene may be
compromised
Laundry may occur
off-plot
High
Provision of improved
level of service
Hygiene education
Household water
treatment and safe
storage as interim
measure
Approximately
50 litres per
capita per day on
average
Low
Hygiene should not
be compromised
Laundry likely to
occur on-plot
Low
Hygiene promotion still
yields health gains
Encourage optimal
access
Optimal
access
Very low
Very low
Hygiene should not Hygiene promotion still
be compromised
yields health gains
Laundry will occur
on-plot
Supply of water
through multiple
taps within the
house
Source: Domestic water quantity, service level and health (supporting document in Annex 1)
The quantities of water collected and used by households are primarily a function of the distance to the water supply or total collection time required. This broadly equates to the level of service. Four levels of service can be defined, as shown in
Table 5.1.
Service level is a useful and easily measured indicator that provides a valid surrogate for the quantity of water collected by households and is the preferred indicator
for surveillance. Available evidence indicates that health gains accrue from improving
service level in two key stages: the delivery of water within 1 km or 30 minutes of total
collection time; and when supplied to a yard level of service. Further health gains
are likely to occur once water is supplied through multiple taps, as this will increase
water availability for diverse hygiene practices. The volume of water collected may also
depend on the reliability and cost of the water. Therefore, collection of data on these
indicators is important.
84
5. SURVEILLANCE
5.3.2 Accessibility
From the public health standpoint, the proportion of the population with reliable access to safe drinking-water is the most important single indicator of the overall success
of a drinking-water supply programme.
There are a number of definitions of access (or coverage), many with qualifications regarding safety or adequacy. Access to safe drinking-water for the Millennium
Development Goals is currently measured by the WHO/United Nations Childrens
Fund (UNICEF) Joint Monitoring Programme for Water Supply and Sanitation
through a proxy that assesses the use of improved drinking-water sources by households. An improved drinking-water source is one that by the nature of its construction
and design adequately protects the source from outside contamination, in particular
by faecal matter. The underlying assumption is that improved sources are more likely
to supply safe drinking-water than unimproved sources. Improved and unimproved
water supply technologies are summarized below:
Determining the proportion of a population with reliable access to drinkingwater is an important function of a drinking-water surveillance agency. This task can
be facilitated by establishing a common definition for reasonable access, appropriate
to a local context, which may describe a minimum quantity of water supplies per
person per day together with a maximum tolerable distance/time to a source (e.g. 20
litres, and within 1 km/30 minutes, respectively, for basic access).
5.3.3 Affordability
The affordability of water has a significant influence on the use of water and selection of water sources. Households with the lowest levels of access to safe water supply
frequently pay more for their water than do households connected to a piped water
system. The high cost of water may force households to use alternative sources of
water of poorer quality that represent a greater risk to health. Furthermore, high costs
1
Bottled water is considered to be improved only when the household uses drinking-water from an
improved source for cooking and personal hygiene.
85
of water may reduce the volumes of water used by households, which in turn may
influence hygiene practices and increase risks of disease transmission.
When assessing affordability, it is important to collect data on the price at the
point of purchase. Where households are connected to the drinking-water supplier,
this will be the tariff applied. Where water is purchased from public standpipes or
from neighbours, the price at the point of purchase may be very different from the
drinking-water supplier tariff. Many alternative water sources (notably vendors) also
involve costs, and these costs should be included in evaluations of affordability. In
addition to recurrent costs, the costs for initial acquisition of a connection should also
be considered when evaluating affordability.
5.3.4 Continuity
Interruptions to drinking-water supply, either because of intermittent sources or resulting from engineering inefficiencies, are a major determinant of the access to and
quality of drinking-water. Analysis of data on continuity of supply requires the consideration of several components. Continuity can be classified as follows:
year-round service from a reliable source with no interruption of flow at the tap
or source;
year-round service with frequent (daily or weekly) interruptions, of which the
most common causes are:
restricted pumping regimes in pumped systems, whether planned or due to
power failure or sporadic failure;
peak demand exceeding the flow capacity of the transmission mains or the
capacity of the reservoir;
excessive leakage within the distribution system;
excessive demands on community-managed point sources;
seasonal service variation resulting from source fluctuation, which typically has
three causes:
natural variation in source volume during the year;
volume limitation because of competition with other uses, such as irrigation;
periods of high turbidity when the source water may be untreatable;
compounded frequent and seasonal discontinuity.
These classifications reflect broad categories of continuity, which are likely to affect
hygiene in different ways. Any interruption of service is likely to result in degradation of
water quality, increased risk of exposure to contaminated water and therefore increased
risk of waterborne disease. Daily or weekly discontinuity results in low supply pressure
and a consequent risk of in-pipe recontamination. Other consequences include reduced
availability and lower volume use, which adversely affect hygiene. Household water
storage may be necessary, and this may lead to an increase in the risk of contamination
during such storage and associated handling. Seasonal discontinuity often forces users
to obtain water from inferior and distant sources. As a consequence, in addition to the
obvious reduction in quality and quantity, time is lost in water collection.
86
5. SURVEILLANCE
Establishing national priorities: When the most common problems and shortcomings in the drinking-water system have been identified, national strategies can
be formulated for improvements and remedial measures; these might include
changes in training (of managers, administrators, engineers or field staff), rolling
programmes for rehabilitation or improvement or changes in funding strategies
to target specific needs.
Establishing subnational/regional priorities: Regional offices of drinking-water supply agencies can decide in which communities to work and which remedial activities
are priorities; public health criteria should be considered when priorities are set.
Establishing hygiene education programmes: Not all of the problems revealed by
surveillance are technical in nature, and not all are solved by drinking-water suppliers; surveillance also looks at problems involving community and household
supplies, water collection and transport and household treatment and storage.
The solutions to many of these problems are likely to require educational and
promotional activities.
Auditing of WSPs and upgrading: The information generated by surveillance can
be used to audit WSPs and to assess whether these are in compliance. Drinking-water systems and their associated WSPs should be upgraded where they are
found to be deficient, although feasibility must be considered, and enforcement
of upgrading should be linked to strategies for progressive improvement.
Ensuring community operation and maintenance: Support should be provided by a
designated authority to enable community members to be trained so that they are
able to assume responsibility for the operation and maintenance of community
drinking-water supplies.
Establishing public awareness and information channels: Publication of information on public health aspects of drinking-water supplies, water quality and the
performance of suppliers can encourage suppliers to follow good practices, mobilize public opinion and response and reduce the need for regulatory enforcement, which should be an option of last resort.
Implementing programmes for household water treatment and safe storage: If information from surveillance reveals no or only basic access to water service, as defined in Table 5.1, or unsafe supplied water, the implementation of programmes to
promote household water treatment and safe storage may be advised to improve
water quality and promote hygienic water management at the household level.
These may be effective interim measures for provision of safer water supported
by appropriate outreach, education and training activities and creating supply
87
chains for appropriate household water treatment and safe storage technologies.
Further information is available in section 7.3.2 and the 1997 volume, Surveillance and control of community supplies (WHO, 1997).
In order to make best use of limited resources where surveillance is not yet practised, it is advisable to start with a basic programme that develops in a planned manner. Activities in the early stages should generate enough useful data to demonstrate
the value of surveillance. Thereafter, the objective should be to progress to more advanced surveillance as resources and conditions permit.
The activities normally undertaken in the initial, intermediate and advanced stages
of development of drinking-water supply surveillance are summarized as follows:
Initial phase:
Establish requirements for institutional development.
Provide training for staff involved in the programme.
Define the role of participants (e.g. quality assurance/quality control by
supplier, surveillance by public health authority).
Develop methodologies suitable for the area.
Commence routine surveillance in priority areas (including inventories).
Limit verification to essential parameters and known problem substances.
Establish reporting, filing and communication systems.
Advocate improvements according to identified priorities.
Establish reporting to local suppliers, communities, media and regional
authorities.
Establish liaison with communities; identify community roles in surveillance
and means of promoting community participation.
Intermediate phase:
Train staff involved in the programme.
Establish and expand systematic routine surveillance.
Expand access to analytical capability (often by means of regional laboratories,
national laboratories being largely responsible for analytical quality control
and training of regional laboratory staff).
Undertake surveys for chemical contaminants using a wider range of analytical
methods.
Evaluate all methodologies (sampling, analysis, etc.).
Use appropriate standard methods (e.g. analytical methods, fieldwork
procedures).
Develop capacity for statistical analysis of data.
Establish a national database.
Identify common problems and improve activities to address them at regional
and national levels.
Expand reporting to include interpretation at the national level.
Draft or revise health-based targets as part of a framework for safe drinkingwater.
Use legal enforcement where necessary.
Involve communities routinely in surveillance implementation.
88
5. SURVEILLANCE
Advanced phase:
Provide further or advanced training for staff involved in the programme.
Establish routine surveillance for all health and acceptability parameters at
defined frequencies.
Use a full network of national, regional and local laboratories (including
analytical quality control).
Use a national framework for drinking-water quality.
Improve water services on the basis of national and local priorities, hygiene
education and enforcement of standards.
Establish regional database archives compatible with the national database.
Disseminate data at all levels (local, regional and national).
Involve communities routinely in surveillance implementation.
In many communities, however, the simple right of access to information will not
ensure that individuals are aware of the quality or safety of the water supplied to them.
The agencies responsible for surveillance should develop strategies for disseminating
and explaining the significance of results obtained.
It may not be feasible for the surveillance agency to provide feedback information directly to the entire community. Thus, it may be appropriate to use community
organizations, where these exist, to provide an effective channel for providing feedback information to users. Some local organizations (e.g. local councils and community-based organizations, such as womens groups, religious groups and schools)
have regular meetings in the communities that they serve and can therefore provide
a mechanism of relaying important information to a large number of people within
the community. Furthermore, by using local organizations, it is often easier to initiate
a process of discussion and decision-making within the community concerning water
quality. The most important element in working with local organizations is to ensure
that the organization selected can access the whole community and can initiate discussion on the results of surveillance (see sections 7.6.1 and 8.7).
5.5.2 Regional use of data
Strategies for regional prioritization are typically of a medium-term nature and have
specific data requirements. While the management of information at a national level is
aimed at highlighting common or recurrent problems, the objective at a regional level
is to assign a degree of priority to individual interventions. It is therefore important
to derive a relative measure of health risk. Although this information cannot be used
on its own to determine which systems should be given immediate attention (which
would also require the analysis of economic, social, environmental and cultural factors), it provides an extremely important tool for determining regional priorities. It
should be a declared objective to ensure that remedial action is carried out each year
on a predetermined proportion of the systems classified as high risk.
At the regional level, it is also important to monitor the improvement in (or deterioration of) both individual drinking-water supplies and the supplies as a whole.
In this context, simple measures, such as the mean sanitary inspection score of all
systems, the proportion of systems with given degrees of faecal contamination, the
population with different levels of service and the mean cost of domestic consumption, should be calculated yearly and changes monitored.
As shown in Table 7.10 in section 7.4, the aim should be to provide drinkingwater that contains no faecal indicator organisms, such as Escherichia coli. However, in
many developing and developed countries, a high proportion of household and small
community drinking-water systems, in particular, fail to meet requirements for water
safety, including the absence of E. coli. In such circumstances, it is important that
realistic goals for progressive improvement are agreed upon and implemented. It is
practical to classify water quality results in terms of an overall grading for water safety
linked to priority for action, as illustrated in Table 5.2.
Grading schemes may be of particular use in community supplies where the
frequency of testing is low and reliance on analytical results alone is especially inappropriate. Such schemes will typically take account of both analytical findings
90
5. SURVEILLANCE
Table 5.2 Example of categorization of drinking-water systems on the basis of population size
and quality rating in order to prioritize actions (see also Table 7.10)
Proportion (%) of samples negative for E. coli
Quality of drinkingwater systema
< 5000 population 5000100 000 population > 100 000 population
90
95
99
80
90
95
70
85
90
60
80
85
E. coli
classificationb
02
35
68
910
A
B
C
D
Low risk:
no action required
High risk:
higher action priority
Where there is a potential discrepancy between the results of the microbial water quality assessment and the sanitary
inspection, further follow-up or investigation is required.
b
Classifications based on those shown in Table 5.2. Quality decreases from A to D.
Source: Adapted from Lloyd & Bartram (1991). See also the supporting document Rapid assessment of drinking-water
quality (Annex 1).
a
and results of the sanitary inspection through matrices such as the one illustrated
in Table 5.3.
Combined analysis of sanitary inspection and water quality data can be used to
identify the most important causes of and control measures for contamination. This
is important to support effective and rational decision-making. For instance, it will
be important to know whether on-site or off-site sanitation could be associated with
contamination of drinking-water, as the remedial actions required to address either
source of contamination will be very different. This analysis may also identify other
factors associated with contamination, such as heavy rainfall. As the data will be nonparametric, suitable methods for analysis include chi-square, odds ratios and logistic
regression models.
Combined analysis of sanitary inspection and water quality data is especially useful in assessing household water management systems. Microbial water quality data
91
Table 5.4 Example of assessment of priority of remedial action for household drinking-water
systems based on a grading system of microbial quality and sanitary inspection
rating or scoresa
Sanitary inspection risk score
(susceptibility of supply to contamination from human and animal faeces)
E. coli classification
(as decimal
concentration/100)
02
68
910
<1
110
11100
> 100
35
Where there is a potential discrepancy between the results of the microbial water quality assessment and the sanitary
inspection, further follow-up or investigation is required.
are often limited, and sanitary inspection risk scoring therefore becomes an important
consideration in assessing household water systems, their management and priority
for remedial actions. An example of a combined system to assess risk and prioritize
remedial actions for household water systems is shown in Table 5.4.
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6
Application of the Guidelines in
specific circumstances
Introduction
(Chapter 1)
hese
Guidelines
FRAMEWORK FOR SAFE DRINKING-WATER
SUPPORTING
provide a generally
INFORMATION
applicable approach to
Health-based targets
Public health context
Microbial aspects
(Chapter 3)
and health outcome
(Chapters 7 and 11)
ensuring the safety of
Chemical aspects
Water safety plans
drinking-water supplied
(Chapters 8 and 12)
(Chapter 4)
through piped distribuRadiological
System
Management and
Monitoring
tion and community
aspects
assessment
communication
(Chapter 9)
supplies. This chapter
Acceptability
describes the application
Surveillance
aspects
(Chapter 5)
(Chapter 10)
of the Guidelies in some
commonly encountered
circumstances and specifApplication of the Guidelines
in specific circumstances
ic issues that should be
(Chapter 6)
taken into account in
Climate change, Emergencies,
Rainwater harvesting, Desalination
each. The sections are not
systems, Travellers, Planes and
intended to stand alone,
ships, etc.
and reference is made to
more comprehensive supporting documents that provide detailed guidance. In all the
specific circumstances described below, the principles enshrined in water safety plans
(WSPs) apply. However, the WSP should be tailored to the type of supply in each circumstance; for example, routine chemical and microbiological monitoring of rainwater
may not be feasible at a household level, but preventive barriers are both applicable and
achievable.
As indicated in chapter 4, WSPs require careful consideration of possible hazards,
and forward planning is one of the important requirements in ensuring that both the
quantity and quality of water supplies are maintained. One of the significant concerns
for the future is climate change, but there remains considerable uncertainty as to its
93
impact on a local or even subregional level. Nevertheless, it is expected that all types of
supply will be affected, including the specific circumstances discussed below.
and storage tanks, and treatment, as appropriate, supported by good hygiene at point
of use, can offer drinking-water with very low health risk.
Rainwater is initially relatively free from impurities, except those picked up by the
rain from the atmosphere. However, the quality of rainwater may subsequently deteriorate during harvesting, storage and household use. Wind-blown dirt, leaves, faecal
droppings from birds and other animals, insects and litter on the catchment areas,
such as roofs and in cisterns, can contaminate rainwater, as can particles from the
atmosphere, such as soot from burning materials (e.g. old tyres). Regular cleaning of
catchment surfaces and gutters should be undertaken to minimize the accumulation
of debris. Wire meshes or inlet filters should be placed over the top of downpipes to
prevent leaves and other debris from entering storage containers and cleaned regularly
to prevent clogging.
Materials used in the catchment and storage tank should be approved for use in
contact with drinking-water and should not leach contaminants or cause taste, odour
or discoloration. As rainwater is slightly acidic and very low in dissolved minerals, it
can dissolve metals and other impurities from materials of the catchment and storage tank, resulting in unacceptably high concentrations of contaminants in the water.
Most solid roof materials are suitable for collecting rainwater, but roofs with bitumenbased coatings are generally not recommended, as they may leach hazardous substances or cause taste problems. Care should be taken to ensure that lead-based paints are
not used on roof catchments. Thatched roofs can cause discoloration or deposition of
particles in collected water.
Poor hygiene in water storage and abstraction from storage containers or at the
point of use can also represent a health concern, but risks can be minimized by good
design and practice. Faecal contamination is quite common, particularly in samples
collected shortly after rainfall, but can be minimized by good practice. Higher microbial concentrations are generally found in the first flush of rainwater, decreasing as
the rain continues; therefore, microbial contamination is less in rainy seasons when
catchments are frequently washed with fresh rainwater. A system to divert the contaminated first flow of rainwater from roof surfaces is necessary, and automatic devices
that prevent the first flush of runoff from being collected in storage are recommended.
If diverters are not available, a detachable downpipe can be used manually to provide
the same result.
Storage tanks can present breeding sites for mosquitoes, including species that
transmit dengue virus (see section 8.6). Covers discourage mosquito breeding and
help to prevent faecal contaminants and sunlight, which will promote algal growth,
from reaching the water. Covers should be fitted, and openings need to be protected
by mosquito-proof mesh. Cracks in the tank can result in contamination of stored
water, whereas water withdrawal using contaminated containers is a potential cause
of both faecal and chemical contamination. Storage containers should preferably be
fitted with a mechanism such as a tap or outlet pipe that enables hygienic abstraction
of water.
Further treatment at the point of consumption may be applied to ensure better
quality of drinking-water and reduce health risk. Solar water disinfection and pointof-use chlorination are examples of low-cost disinfection options for the treatment
95
of stored rainwater. These and other household water treatment technologies are discussed in more detail in sections 7.3.2 (microbial) and 8.4.4 (chemical).
water at kiosks or used on carts and tanker trucks should be protected from contamination (e.g. by preventing contact of the ends with the ground) and drained when
not in use. The area around standpipes should include drainage or be constructed in
a manner to prevent pooling of water. Materials used in all components, including
pipework, containers and hoses, need to be suitable for use in contact with drinkingwater and should not result in contamination of the water with hazardous chemicals
or with substances that could adversely affect its taste.
All components of water vending, including sources, methods of abstraction and
transport, should be incorporated into a WSP. Where vendors are registered or have
a contract with a water utility, implementation and operation of the WSP should be
regularly checked by the utility. WSPs and the operation of water vendors should also
be subject to independent surveillance.
and transfer of substances such as petroleum hydrocarbons could diminish the structural integrity of the pipe materials or render the water unpalatable to consumers.
Such piping is most likely to be found in transfer hoses, so the cleanliness of the transfer points where tankers are used is vital, as is protection of the transfer area from spills
of petroleum fuels.
Implementation of security measures to guard against intentional contamination
and theft may also be warranted.
public communication about the potential health risks from exposure to nonpotable water through cross-connections and the dangers of modifying systems
by inexperienced and non-certified individuals.
Increasingly in developed countries, dual systems are being installed at a household level or in public buildings. Guidance should be provided on installation, particularly where this is by non-certified individuals. Potable water supplied into the
building should be fitted with a non-return valve in order to prevent backflow into
the public water supply.
99
100
The quantity of water available and the reliability of supply: These are likely to
102
Temporary water supply systems can vary substantially in terms of their scale, period of operation, water use and fluctuations in demand, and these variations should
be taken into consideration during the planning and design stages. In the case of an
independent system, adequate consideration should also be given to the selection of
a water source in terms of quantity, quality and treatment processes, and care should
be taken not to adversely affect any other supply or water source. Where a temporary
system is directly connected to a mains water supply, it is important to prevent the
accidental contamination of the mains water supply through backflow during construction and operation of the temporary system. Water consumption for firefighting,
hand washing and toilet flushing should be taken into account in estimating total and
predictable variations in water demand where there are no other water sources available for such purposes.
Water quality targets for temporary supplies should be the same as those for
permanent water supplies. Disinfection should be considered indispensable in a temporary supply, and it is preferable to maintain a certain level of disinfectant (e.g. chlorine) residual at service taps. If the supply is not for potable uses, appropriate action
should be taken to ensure that it is not used for drinking.
If a temporary water supply is used recurrently, it is essential to fully flush the
entire system with water containing a higher than normal disinfectant residual before
restarting. When planning installation on site, positioning of pipes, hoses and connections should take risks of contamination into accountfor example, by avoiding the placement of hosing and fittings on the ground near sites of potential faecal
contamination or storage tanks in direct sunlight where rising temperatures support
microbial growth. It is also important to ensure that the facility has no defects, including leakage, that could cause the deterioration of water quality and that water quality
at every service tap satisfies the required quality target. Important control measures
during dismantling and transport of installations include emptying hoses, preferably
drying them and storing them so that ingress of contamination is avoided. In all cases,
the materials should be approved for use in contact with potable water.
Care should be taken in planning and designing wastewater management and
disposal facilities, particularly to ensure that lavatories and disposal facilities are located so as to avoid any risk of adversely affecting source water quality or stored water.
It is also important to prevent runoff from other areas, such as livestock pens, from
entering the source. The source, treatment facilities and distribution reservoirs should
be well protected from access by animals (e.g. bird faeces) and humans by covers or
roofs.
A temporary system is usually more vulnerable to accidental and deliberate contamination than an existing permanent water supply system, and attention needs to
be paid to security. All water treatment facilities should be thoroughly inspected at
least every day. All of these procedures and requirements should be included in the
operational management documents that are at the core of the WSP.
Signs are an important part of ensuring that water from taps is used appropriately and the protection of water sources and drinking-water infrastructure. The
signs should be easily understood and used in conjunction with other barriers, such
as fences.
103
Water quality and appearance should be routinely monitored at the service taps
of a temporary water supply system. At the very least, water temperature and disinfectant residual should be monitored every day as simple rapid tests that act as indicators
of possible problems. Other basic parameters that should be regularly monitored, if
possible, include pH, conductivity, turbidity, colour and Escherichia coli (or, alternatively, thermotolerant coliforms). Routine sanitary inspection of a temporary water
supply by the appropriate health authority is very important. If any problem related to
water quality arises, remedial actions that are included in the management documents
supporting the WSP should be taken promptly. If a temporary water supply system is
to be used for a period of more than a few weeks, regular surveillance by the appropriate health authority should be implemented.
6.9 Buildings1
Drinking-water systems in buildings can be a significant source of contamination, and
poor management of these systems has contributed to outbreaks of disease and illness.
One of the challenges in ensuring water safety is that responsibility for many actions
essential to the control of drinking-water quality in buildings is often outside the mandate of the drinking-water supplier. Roles and responsibilities of different stakeholders relating to the safe management of drinking-water systems within buildings can be
influenced by a number of factors, including ownership of assets and rights of access.
WSPs established for management of public water supplies are not typically extended
to buildings, although the water supplier WSP may include a number of initiatives to
ensure that backflow prevention is in place or to provide information to consumers on
protecting their own water quality. In many cases, owners, managers or maintenance
personnel are responsible for managing building water supplies, but awareness and
application of drinking-water guidelines are often limited, and so educational supporting programmes may be required.
The design of water networks in buildings is variable, as influenced by the diversity of building types (e.g. schools, child-care facilities, residential buildings, hotels,
sports facilities, factories, office blocks, museums, transport terminals), designs and
water uses. Drinking-water systems in buildings are typically divided into hot and cold
water networks and may be connected to water-based devices (e.g. cooling towers,
boilers, swimming pools) or point-of-use equipment (e.g. washing machines).
General drinking-water safety is ensured by good management practices, including sound design, routine maintenance protocols, regular cleaning, temperature management and flow management (avoidance of stagnation). These practices should be
incorporated in WSPs developed by building owners or managers. WSPs for buildings
should address cold and hot drinking-water networks and consider water-based devices and point-of-use equipment. Regulatory or other appropriate authorities may
provide guidance on the development and application of WSPs for drinking-water
systems in buildings.
Hospitals, nursing care homes and other health-care facilities are discussed in section 6.10.
104
105
The aim of a distribution system within a large building is to supply safe drinking-water at adequate pressure and flow. The quality of water entering building supplies will be ensured by a water utility or by the installation of point-of-entry devices
typically managed by the building owner or operator. To maintain drinking-water
quality, it is important to minimize transit times, low flows and low pressures.
Procedures should be established for repairs, renovations or extensions of systems
to ensure that water safety is maintained, and all work, including changes to water systems, should be documented. Following work on the system, it would be appropriate
to disinfect and flush.
Monitoring should focus on ensuring that control measures are working effectively. Where possible, this should include monitoring by maintenance personnel using
field kits for parameters such as temperature, pH and disinfectant residuals. The frequency will vary depending on the size and use of the building, but it should be weekly
in large buildings. Monitoring of drinking-water quality will be more frequent when
the building is new or recently commissioned.
Independent surveillance is a desirable element in ensuring continued water safety within buildings and should be undertaken by the relevant health agency or other
independent authority.
To ensure the safety of drinking-water within buildings, supportive activities of
national regulatory agencies include:
suitable education and training programmes for building owners and managers,
For further guidance, see the supporting document Water safety in buildings
(Annex 1).
No vaccine is capable of conferring general protection against infectious diarrhoea, which is caused by many different pathogens. It is important that travellers be
aware of the possibility of illness and take appropriate steps to minimize the risks. Preventive measures while living or travelling in areas with questionable drinking-water
quality include the following:
108
109
Boiling
Chlorine compounds:
1. Unscented household bleach
(sodium hypochlorite)
2. Sodium dichloroisocyanurate
tablet
3. Calcium hypochlorite
Flocculant-chlorine tablet or
sachet
Recommendation
Method
What it does
110
111
Iodine:
1. Tincture of iodine (2%
solution)
2. Iodine (10% solution)
3. Iodine tablet
4. Iodinated (triiodide or
pentaiodide) resin
What it does
a
To make a 1% stock solution of calcium hypochlorite, add (to 1 litre of water) 28 g if chlorine content is 35%, 15.4 g if chlorine content is 65% or 14.3 g if chlorine content is 70%.
Recommendation
Method
The airport authority has responsibility for safe drinking-water supply, including
operational monitoring, until water is transferred to the aircraft operator. The primary emphasis of monitoring is to ensure that management processes are operating
efficientlyfor example, the source water quality is not compromised; all parts of the
system, including hydrants, hoses and bowsers, are clean and in good repair; backflow
prevention is in place; and any filters are clean. In addition, the system should be disinfected and flushed after maintenance or repairs, and the microbiological quality of
the water should be checked, preferably before the system is returned to service.
Transfer of water into the aircraft and the aircraft drinking-water system also
has the potential to introduce hazards, even if the water is of good quality up to this
point. It is therefore important that staff involved be properly trained and understand the reasons for the precautions to be taken and the care required in preventing
contamination. The precautions described in previous sections regarding transfer of
drinking-water from a piped supply or from bowsers and tankers are essential, including maintaining the cleanliness of vehicles and transfer points. There is a significant
potential for aviation fuel to contaminate the system, and only small quantities of low
molecular weight hydrocarbons can cause the water to be unacceptable. In addition,
staff employed in drinking-water supply must not be engaged in activities related to
aircraft toilet servicing without first taking all necessary precautions (e.g. thorough
hand washing, change of outer garments). All of these requirements and procedures
should be properly documented as part of the WSP for the airport water transfer
system and should be made clear to airlines using the airport to ensure that they play
their part as key stakeholders.
Independent surveillance is an important part of the WSP, because circumstances
and equipment or staff may change, and the weakening of barriers or the introduction of new risks may not be noticed. This would include initial review and approval
of the WSP, periodic review and direct assessment of the provisions and operation of
the WSP, paying specific attention to the aircraft industrys codes of practice, the supporting document Guide to hygiene and sanitation in aviation (Annex 1) and airport
health or airline regulations. It is also important that the response to any incident is
recorded and reviewed and any lessons learnt incorporated into the WSP.
6.13 Ships
The importance of water as a vehicle for infectious disease transmission on ships has
been clearly documented. In general terms, the greatest microbial risks are associated
with ingestion of water that is contaminated with human and animal excreta. However,
112
quality of source water if this is from a shore-based source along with the equipment and method of transfer from shore to ship;
desalination equipment and processes where these are used, taking into consideration the points raised in section 6.5;
113
design and construction of storage tanks and pipework, including the use of ap
proved materials and chemicals and clear colour coding of pipes for different
purposes;
minimization of dead ends and areas of stagnation, which may be managed by
periodic flushing;
filtration systems and other treatment systems on board the ship, including disinfection and delivery of residual disinfection;
prevention of cross-connections and presence of working backflow prevention
devices;
maintenance of adequate water pressure within the system;
presence of a disinfectant residual throughout the system.
The system needs to be checked regularly for cleanliness and repair, and parameters such as pH and disinfectant residual need to be checked daily. Where possible,
checks on microbiological quality such as plate counts and faecal coliforms, even if
only in port, help to ensure that the supply continues to deliver safe water. There also
need to be suitable procedures in place to ensure safety after maintenance or repair,
including specific disinfection of the system or the affected zone. Any indication of a
problem, such as illness or taste or odour problems, should be immediately investigated and the system corrected if it is shown to be the source. In confined communities such as on ships, person-to-person spread of infectious disease is a major issue.
Someone who has been working on the latrines and sanitation system on ships should
not transfer to work on the drinking-water system without thorough hand washing
and a change of outer clothing.
Independent surveillance is a desirable element in ensuring drinking-water safety
on ships. This implies that there will be periodic audit and direct assessment and the
review and approval of the WSP. Specific attention should be given to the shipping industrys codes of practice, the supporting document Guide to ship sanitation (Annex 1)
and port health and shipping regulations. Independent surveillance should also include
ensuring that any specific incidents that affect or might have affected water quality have
been properly investigated and the lessons to be learnt are incorporated in the WSP.
The Guidelines provide a basis for derivation of standards for all packaged waters. As with other sources of drinking-water, safety is pursued through a combination
of safety management and end product quality standards and testing and is more
readily achievable because batches can be held until results are available. The international framework for packaged water regulation is provided by the Codex Alimentarius Commission of the World Health Organization and the Food and Agriculture
Organization of the United Nations.
The Codex Alimentarius Commission has developed a Standard for natural
mineral waterswhich describes the product and its compositional and quality
factors, including prescribed treatments, limits for certain chemicals, hygiene, packaging and labellingand an associated Code of Practice. It has also developed a
Standard for bottled/packaged waters to cover packaged drinking-water other than
natural mineral waters. Both relevant Codex standards refer directly to these Guidelines; the Codex standards for bottled/packaged water are directly equivalent to the
guideline values established in these Guidelines. Under the Codex Standard for natural mineral waters and associated Code of Practice, natural mineral waters must
conform to strict requirements, including collection and bottling without further
treatment from a natural source, such as a spring or well. In comparison, the Codex
Standard for bottled/packaged waters includes waters from other sources, in addition to springs and wells, and treatment to improve their safety and quality. The
distinctions between these standards are especially relevant in regions where natural
mineral waters have a long cultural history. For further information on the Codex
Standard for natural mineral waters and its companion Code of Practice and the
Codex Standard for bottled/packaged waters, readers are referred to the Codex web
site (http://www.codexalimentarius.net/).
The Codex Alimentarius Commissions Code of practice for collecting, processing
and marketing of natural mineral waters provides guidance on a range of good manufacturing practices and provides a generic WSP applied to packaged drinking-water.
Some consumers believe that certain natural mineral waters have medicinal properties or offer other health benefits. Some such waters have higher mineral content,
sometimes significantly higher than concentrations normally accepted in drinkingwater. They often have a long tradition of use and are often accepted on the basis that
they are considered foods rather than drinking-water per se. Although certain mineral
waters may be useful in providing essential micronutrients, such as calcium and magnesium, these Guidelines do not make recommendations regarding minimum concentrations of essential elements because of the uncertainties surrounding mineral
nutrition from drinking-water. Packaged waters with very low mineral content, such
as distilled or demineralized waters, are also consumed. There is insufficient scientific
information on the benefits or hazards of long-term consumption of very low mineral
waters to allow any recommendations to be made (WHO, 2005b; see also the supporting document Calcium and magnesium in drinking-water; Annex 1).
Another form of packaged water is ice that is intended for adding to drinks and
which may come into contact with food to be eaten without cooking. Ice prepared
and sold in this manner should be treated the same as any packaged water for potable
use.
115
116
7
Microbial aspects
Introduction
(Chapter 1)
he greatest risk to
FRAMEWORK FOR SAFE DRINKING-WATER
SUPPORTING
public health from
INFORMATION
microbes in water is assoHealth-based targets
Public health context
Microbial aspects
(Chapter 3)
and health outcome
(Chapters 7 and 11)
ciated with consumption
Chemical aspects
Water safety plans
of drinking-water that is
(Chapters 8 and 12)
(Chapter 4)
contaminated with huRadiological
System
Management and
Monitoring
man and animal excreta,
aspects
assessment
communication
(Chapter 9)
although other sources
Acceptability
and routes of exposure
Surveillance
aspects
(Chapter 5)
(Chapter 10)
may also be significant.
This chapter focuses
on organisms for which
Application of the Guidelines
in specific circumstances
there is evidence, from
(Chapter 6)
outbreak studies or from
Climate change, Emergencies,
Rainwater harvesting, Desalination
prospective studies in
systems, Travellers, Planes and
non-outbreak situations,
ships, etc.
of diseases being caused
by ingestion of drinking-water, inhalation of water droplets or dermal contact with
drinking-water and their prevention and control. For the purpose of the Guidelines,
these routes are considered waterborne.
Chapter 11 (Microbial fact sheets) provides additional detailed information on
individual waterborne pathogens, as well as on indicator microorganisms.
117
Breakdown in water supply safety (source, treatment and distribution) may lead to
large-scale contamination and potentially
to detectable disease outbreaks. In some
Infectious diseases caused by pathogenic
cases, low-level, potentially repeated conbacteria, viruses, protozoa and helminths
are the most common and widespread
tamination may lead to significant sporhealth risk associated with drinking-water.
adic disease, but public health surveillance
is unlikely to identify contaminated drinking-water as the source.
Waterborne pathogens have several properties that distinguish them from other
drinking-water contaminants:
7. MICROBIAL ASPECTS
Pathogen
Persistence
Health
in water
significanceb suppliesc
Bacteria
Burkholderia pseudomallei
High
Campylobacter jejuni, C. coli
High
Escherichia coli Pathogenicf High
E. coli Enterohaemorrhagic High
Francisella tularensis
High
Legionella spp.
High
Leptospira
High
Mycobacteria (nonLow
tuberculous)
Salmonella Typhi
High
Other salmonellae
High
Shigella spp.
High
Vibrio cholerae
High
Viruses
Adenoviruses
Moderate
Astroviruses
Moderate
Enteroviruses
High
Hepatitis A virus
High
Hepatitis E virus
High
Noroviruses
High
Rotaviruses
High
Sapoviruses
High
Protozoa
Acanthamoeba spp.
High
Cryptosporidium hominis/
High
parvum
Cyclospora cayetanensis
High
Entamoeba histolytica
High
Giardia intestinalis
High
Naegleria fowleri
High
Helminths
Dracunculus medinensis
Schistosoma spp.
High
High
Resistance
Important
to
Relative
animal
chlorined
infectivitye source
May multiply
Moderate
Moderate
Moderate
Long
May multiply
Long
May multiply
Low
Low
Low
Low
Moderate
Low
Low
High
Low
Moderate
Low
High
High
Moderate
High
Low
No
Yes
Yes
Yes
Yes
No
Yes
No
Moderate
May multiply
Short
Short to longg
Low
Low
Low
Low
Low
Low
High
Low
No
Yes
No
No
Long
Long
Long
Long
Long
Long
Long
Long
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
High
High
High
High
High
High
High
High
No
No
No
No
Potentially
Potentially
No
Potentially
May multiply
Long
High
High
High
High
No
Yes
Long
Moderate
Moderate
May multiplyh
High
High
High
Low
High
High
High
Moderate
No
No
Yes
No
Moderate
Short
Moderate
Moderate
High
High
No
Yes
This table contains pathogens for which there is some evidence of health significance related to their occurrence in
drinking-water supplies. More information on these and other pathogens is presented in chapter 11.
Health significance relates to the incidence and severity of disease, including association with outbreaks.
c
Detection period for infective stage in water at 20 C: short, up to 1 week; moderate, 1 week to 1 month; long, over
1 month.
d
When the infective stage is freely suspended in water treated at conventional doses and contact times and pH
between 7 and 8. Low means 99% inactivation at 20 C generally in < 1 min, moderate 130 min and high > 30 min.
It should be noted that organisms that survive and grow in biofilms, such as Legionella and mycobacteria, will be
protected from chlorination.
e
From experiments with human volunteers, from epidemiological evidence and from experimental animal studies.
High means infective doses can be 1102 organisms or particles, moderate 102104 and low > 104.
f
Includes enteropathogenic, enterotoxigenic, enteroinvasive, diffusely adherent and enteroaggregative.
g
Vibrio cholerae may persist for long periods in association with copepods and other aquatic organisms.
h
In warm water.
a
119
120
7. MICROBIAL ASPECTS
Table 7.2 Organisms for which transmission through drinking-water has been suggested but
for which evidence is inconclusivea
Pathogen
Presence in
Resistance
water supplies to chlorineb
Level of evidence
Bacteria
Acinetobacter
Low
Aeromonas
Common and
can multiply
Low
Enterobacter sakazakii
Unlikely
Low
Helicobacter pylori
Low
Klebsiella
Low
Moderate
Staphylococcus aureus
Common and
can multiply
Moderate
Tsukamurella
Unknown
Yersinia enterocolitica
Common and
can multiply
Low
Influenza viruses
Unlikely
Low
Unlikely
Unknown
Balantidium coli
Detected
High
Blastocystis hominis
Unknown,
persistencec
likely
High
Isospora belli
Unknown
High
Microsporidia
Detected,
persistencec
likely
Moderate
Toxoplasma gondii
Long
High
Viruses
Protozoa
121
Pathogen
Presence in
Resistance
water supplies to chlorineb
Level of evidence
Helminths
a
b
Fasciola spp.
Detected
High
Free-living nematodes
other than Dracunculus
medinensis
Detected and
can multiply
High
mycobacteria in water; Annex 1). A number of these organisms are listed in Table 7.2
(and described in more detail in chapter 11).
Most of the human pathogens listed in Table 7.1 (which are also described in more
detail in chapter 11) are distributed worldwide; some, however, such as those causing
outbreaks of cholera or guinea worm disease, are regional. Eradication of Dracunculus
medinensis is a recognized target of the World Health Assembly (1991).
It is likely that there are pathogens not shown in Table 7.1 that are also transmitted by water. This is because the number of known pathogens for which water is a
transmission route continues to increase as new or previously unrecognized pathogens
continue to be discovered (WHO, 2003).
7.1.2 Emerging issues
A number of developments are subsumed under the concept of emerging issues in
drinking-water. Global changes, such as human development, population growth and
movement and climate change (see section 6.1), exert pressures on the quality and
quantity of water resources that may influence waterborne disease risks. Between 1972
and 1999, 35 new agents of disease were discovered, and many more have re-emerged
after long periods of inactivity or are expanding into areas where they have not previously been reported (WHO, 2003). In 2003, a coronavirus was identified as the causative agent of severe acute respiratory syndrome, causing a multinational outbreak. Even
more recently, influenza viruses originating from animal reservoirs have been transmitted to humans on several occasions, causing flu pandemics and seasonal epidemic
influenza episodes (see the supporting document Review of latest available evidence on
potential transmission of avian influenza (H5N1) through water and sewage and ways
to reduce the risks to human health; Annex 1). Zoonotic pathogens make up 75% of
the emerging pathogens and are of increasing concern for human health, along with
pathogens with strictly human-to-human transmission. Zoonotic pathogens pose the
greatest challenges to ensuring the safety of drinking-water and ambient water, now
and in the future (see the supporting document Waterborne zoonoses; Annex 1). For
each emerging pathogen, whether zoonotic or not, it should be considered whether it
122
7. MICROBIAL ASPECTS
Ingestion
(Drinking)
Route of
infection
Sepsis and
generalized
infection may
occur
Gastrointestinal
Bacteria
Campylobacter
spp.
E. coli
pathogenic
Francisella
tularensis
Salmonella
spp. including
S. Typhi
Shigella spp.
Vibrio cholerae
Viruses
Adenoviruses
Astroviruses
Enteroviruses
Hepatitis A
virus
Hepatitis E
virus
Noroviruses
Rotaviruses
Sapoviruses
Protozoa and
helminths
Cryptosporidium
hominis/parvum
Cyclospora
cayetanensis
Dracunculus
medinensis
Entamoeba
histolytica
Giardia
intestinalis
Toxoplasma
gondii
Inhalation and
aspiration
(Aerosols)
Contact
(Bathing)
Respiratory
Adenoviruses
Enteroviruses
Legionella
pneumophila
Mycobacteria
(non-tuberculous)
Naegleria fowleri
Acanthamoeba spp.
Burkholderia pseudomallei
Leptospira spp.
Mycobacteria
(non-tuberculous)
Schistosoma mansoni
can be transmitted through water and, if so, which prevention and control measures
can be suggested to minimize this risk.
7.1.3 Persistence and growth in water
Waterborne pathogens, such as Legionella, may grow in water, whereas other hostdependent waterborne pathogens, such as noroviruses and Cryptosporidium, cannot
grow in water, but are able to persist.
Host-dependent waterborne pathogens, after leaving the body of their host, gradually lose viability and the ability to infect. The rate of decay is usually exponential,
and a pathogen will become undetectable after a certain period. Pathogens with low
persistence must rapidly find new hosts and are more likely to be spread by person-toperson contact or poor personal hygiene than by drinking-water. Persistence is affected
by several factors, of which temperature is the most important. Decay is usually faster
at higher temperatures and may be mediated by the lethal effects of ultraviolet (UV)
radiation in sunlight acting near the water surface.
Relatively high amounts of biodegradable organic carbon, together with warm
waters and low residual concentrations of chlorine, can permit growth of Legionella,
Vibrio cholerae, Naegleria fowleri, Acanthamoeba and nuisance organisms in some
surface waters and during water distribution (see also the supporting documents
Heterotrophic plate counts and drinking-water safety and Legionella and the prevention
of legionellosis; Annex 1).
Microbial water quality may vary rapidly and widely. Short-term peaks in pathogen
concentration may increase disease risks considerably and may also trigger outbreaks of
waterborne disease. Microorganisms can accumulate in sediments and are mobilized
when water flow increases. Results of water quality testing for microbes are not normally
available in time to inform management action and prevent the supply of unsafe water.
123
124
7. MICROBIAL ASPECTS
More commonly, QMRA is used as the basis for setting microbial health-based
targets, particularly where the fraction of disease that can be attributed to drinkingwater is low or difficult to measure directly through public health surveillance or
analytical epidemiological studies.
For the control of microbial hazards, the most frequent form of health-based target applied is performance targets (see section 3.3.3), which are anchored to a predetermined tolerable burden of disease and established by applying QMRA taking into
account raw water quality. Water quality targets (see section 3.3.2) are typically not
developed for pathogens; monitoring finished water for pathogens is not considered
a feasible or cost-effective option because pathogen concentrations equivalent to
tolerable levels of risk are typically less than 1 organism per 104105 litres.
7.2.2 Reference pathogens
It is not practical, and there are insufficient data, to set performance targets for all
potentially waterborne pathogens, including bacteria, viruses, protozoa and helminths. A more practical approach is to identify reference pathogens that represent
groups of pathogens, taking into account variations in characteristics, behaviours
and susceptibilities of each group to different treatment processes. Typically, different reference pathogens will be identified to represent bacteria, viruses, protozoa and
helminths.
Selection criteria for reference pathogens include all of the following elements:
Some of the criteria, such as environmental persistence and sensitivity to treatment processes, relate to the specific characteristics of the reference pathogens. Other criteria can
be subject to local circumstances and conditions. These can include waterborne disease
125
burden, which can be influenced by the prevalence of the organism from other sources,
levels of immunity and nutrition (e.g. rotavirus infections have different outcomes
in high- and low-income regions); and occurrence of the organism in source waters
(e.g. presence of toxigenic Vibrio cholerae and Entamoeba histolytica is more common
in defined geographical regions, whereas Naegleria fowleri is associated with warmer
waters).
Selection of reference pathogens
The selection of reference pathogens may vary between different countries and regions and should take account of local conditions, including incidence and severity
of waterborne disease and source water characteristics (see section 7.3.1). Evidence of
disease prevalence and significance should be used in selecting reference pathogens.
However, the range of potential reference pathogens is limited by data availability,
particularly in regard to human doseresponse models for QMRA.
Decision-making regarding selection of reference pathogens should be informed
by all available data sources, including infectious disease surveillance and targeted
studies, outbreak investigations and registries of laboratory-confirmed clinical cases.
Such data can help identify the pathogens that are likely to be the biggest contributors
to the burden of waterborne disease. It is these pathogens that may be suitable choices
as reference pathogens and to consider when establishing health-based targets.
Viruses
Viruses are the smallest pathogens and hence are more difficult to remove by physical
processes such as filtration. Specific viruses may be less sensitive to disinfection than
bacteria and parasites (e.g. adenovirus is less sensitive to UV light). Viruses can persist
for long periods in water. Infective doses are typically low. Viruses typically have a
limited host range, and many are species specific. Most human enteric viruses are not
carried by animals, although there are some exceptions, including specific strains of
hepatitis E virus (Table 7.1).
Rotaviruses, enteroviruses and noroviruses have been identified as potential
reference pathogens. Rotaviruses are the most important cause of gastrointestinal
infection in children and can have severe consequences, including hospitalization and
death, with the latter being far more frequent in low-income regions. There is a dose
response model for rotaviruses, but there is no routine culture-based method for
quantifying infectious units. Typically, rotaviruses are excreted in very large numbers
by infected patients, and waters contaminated by human waste could contain high
concentrations. Occasional outbreaks of waterborne disease have been recorded. In
low-income countries, sources other than water are likely to dominate.
Enteroviruses, including polioviruses and the more recently recognized parechoviruses, can cause mild febrile illness, but are also important causative agents of severe
diseases, such as paralysis, meningitis and encephalitis, in children. There is a dose
response model for enteroviruses, and there is a routine culture-based analysis for measuring infective particles. Enteroviruses are excreted in very large numbers by infected
patients, and waters contaminated by human waste could contain high concentrations.
126
7. MICROBIAL ASPECTS
Noroviruses are a major cause of acute gastroenteritis in all age groups. Symptoms of illness are generally mild and rarely last longer than 3 days; however, infection
does not yield lasting protective immunity. Hence, the burden of disease per case is
lower than for rotaviruses. Numerous outbreaks have been attributed to drinkingwater. A doseresponse model has been developed to estimate infectivity for several
norovirus strains, but no culture-based method is available.
Bacteria
Bacteria are generally the group of pathogens that is most sensitive to inactivation
by disinfection. Some free-living pathogens, such as Legionella and non-tuberculous
mycobacteria, can grow in water environments, but enteric bacteria typically do not
grow in water and survive for shorter periods than viruses or protozoa. Many bacterial
species that are infective to humans are carried by animals.
There are a number of potentially waterborne bacterial pathogens with known
doseresponse models, including Vibrio, Campylobacter, E. coli O157, Salmonella and
Shigella.
Toxigenic Vibrio cholerae can cause watery diarrhoea. When it is left untreated, as
may be the case when people are displaced by conflict and natural disaster, case fatality
rates are very high. The infective dose is relatively high. Large waterborne outbreaks
have been described and keep occurring.
Campylobacter is an important cause of diarrhoea worldwide. Illness can produce
a wide range of symptoms, but mortality is low. Compared with other bacterial pathogens, the infective dose is relatively low and can be below 1000 organisms. It is relatively
common in the environment, and waterborne outbreaks have been recorded.
Waterborne infection by E. coli O157 and other enterohaemorrhagic strains of
E. coli is far less common than infection by Campylobacter, but the symptoms of
infection are more severe, including haemolytic uraemic syndrome and death. The
infective dose can be very low (fewer than 100 organisms).
Shigella causes over 2 million infections each year, including about 60 000 deaths,
mainly in developing countries. The infective dose is low and can be as few as 10100
organisms. Waterborne outbreaks have been recorded.
Although non-typhoidal Salmonella rarely causes waterborne outbreaks, S. Typhi
causes large and devastating outbreaks of waterborne typhoid.
Protozoa
Protozoa are the group of pathogens that is least sensitive to inactivation by chemical
disinfection. UV light irradiation is effective against Cryptosporidium, but Cryptosporidium is highly resistant to oxidizing disinfectants such as chlorine. Protozoa are of a
moderate size (> 2 m) and can be removed by physical processes. They can survive
for long periods in water. They are moderately species specific. Livestock and humans
can be sources of protozoa such as Cryptosporidium and Balantidium, whereas humans are the sole reservoirs of pathogenic Cyclospora and Entamoeba. Infective doses
are typically low.
There are doseresponse models available for Giardia and Cryptosporidium.
Giardia infections are generally more common than Cryptosporidium infections, and
127
128
7. MICROBIAL ASPECTS
Aim
1. Problem formulation and To identify all possible hazards associated with drinking-water that
hazard identification
would have an adverse public health consequence, as well as their
pathways from source(s) to consumer(s)
2. Exposure assessment
To determine the size and nature of the population exposed and the
route, amount and duration of the exposure
3. Doseresponse
assessment
4. Risk characterization
Exposure assessment
Exposure assessment in the context of drinking-water consumption involves estimation of the number of pathogens to which an individual is exposed, principally
through ingestion. Exposure assessment inevitably contains uncertainty and must account for variability of such factors as concentrations of pathogens over time and
volumes ingested.
Exposure can be considered as a single dose of pathogens that a consumer ingests
at a certain point in time or the total amount over several exposures (e.g. over a year).
Exposure is determined by the concentration of pathogens in drinking-water and the
volume of water consumed.
It is rarely possible or appropriate to directly measure pathogens in drinking-water
on a regular basis. More often, concentrations in raw waters are assumed or measured,
and estimated reductionsfor example, through treatmentare applied to estimate
the concentration in the water consumed. Pathogen measurement, when performed,
is generally best carried out at the location where the pathogens are at highest concentration (generally raw waters). Estimation of their removal by sequential control
measures is generally achieved by the use of indicator organisms such as E. coli for
enteric bacterial pathogens (see section 7.4; see also the supporting document Water
treatment and pathogen control in Annex 1).
The other component of exposure assessment, which is common to all pathogens,
is the volume of unboiled water consumed by the population, including person-toperson variation in consumption behaviour and especially consumption behaviour of
vulnerable subpopulations. For microbial hazards, it is important that the unboiled volume of drinking-water, both consumed directly and used in food preparation, is used in
the risk assessment, as heating will rapidly inactivate pathogens. This amount is lower
than that used for deriving water quality targets, such as chemical guideline values.
The daily exposure of a consumer to pathogens in drinking-water can be assessed
by multiplying the concentration of pathogens in drinking-water by the volume of
drinking-water consumed (i.e. dose). For the purposes of the example model calculations, drinking-water consumption was assumed to be 1 litre of unboiled water per
day, but location-specific data on drinking-water consumption are preferred.
129
Doseresponse assessment
The probability of an adverse health effect following exposure to one or more pathogenic organisms is derived from a doseresponse model. Available doseresponse data
have been obtained mainly from studies using healthy adult volunteers. However, adequate data are lacking for vulnerable subpopulations, such as children, the elderly
and the immunocompromised, who may suffer more severe disease outcomes.
The conceptual basis for the doseresponse model is the observation that exposure to the described dose leads to the probability of infection as a conditional event:
for infection to occur, one or more viable pathogens must have been ingested. Furthermore, one or more of these ingested pathogens must have survived in the hosts body.
An important concept is the single-hit principle (i.e. that even a single pathogen may
be able to cause infection and disease). This concept supersedes the concept of (minimum) infectious dose that is frequently used in older literature (see the supporting
document Hazard characterization for pathogens in food and water; Annex 1).
In general, well-dispersed pathogens in water are considered to be Poisson distributed. When the individual probability of any organism surviving and starting infection is the same, the doseresponse relationship simplifies to an exponential function. If, however, there is heterogeneity in this individual probability, this leads to the
beta-Poisson doseresponse relationship, where the beta stands for the distribution
of the individual probabilities among pathogens (and hosts). At low exposures, such
as would typically occur in drinking-water, the doseresponse model is approximately
linear and can be represented simply as the probability of infection resulting from
exposure to a single organism (see the supporting document Hazard characterization
for pathogens in food and water; Annex 1).
Risk characterization
Risk characterization brings together the data collected on exposure, doseresponse
and the incidence and severity of disease.
The probability of infection can be estimated as the product of the exposure by
drinking-water and the probability that exposure to one organism would result in
infection. The probability of infection per day is multiplied by 365 to calculate the
probability of infection per year. In doing so, it is assumed that different exposure
events are independent, in that no protective immunity is built up. This simplification
is justified for low risks only, such as those discussed here.
Not all infected individuals will develop clinical illness; asymptomatic infection
is common for most pathogens. The percentage of infected persons who will develop
clinical illness depends on the pathogen, but also on other factors, such as the immune
status of the host. Risk of illness per year is obtained by multiplying the probability of
infection by the probability of illness given infection.
The low numbers in Table 7.4 can be interpreted to represent the probability that
a single individual will develop illness in a given year. For example, a risk of illness
for Campylobacter of 2.2 104 per year indicates that, on average, 1 out of 4600
consumers would contract campylobacteriosis from consumption of drinking-water.
To translate the risk of developing a specific illness to disease burden per case, the
metric disability-adjusted life year, or DALY, is used (see Box 3.1 in chapter 3). This
130
7. MICROBIAL ASPECTS
metric reflects not only the effects of acute end-points (e.g. diarrhoeal illness) but also
mortality and the effects of more serious end-points (e.g. Guillain-Barr syndrome associated with Campylobacter). The disease burden per case varies widely. For example,
the disease burden per 1000 cases of rotavirus diarrhoea is 480 DALYs in low-income
regions, where child mortality frequently occurs. However, it is 14 DALYs per 1000
cases in high-income regions, where hospital facilities are accessible to the great majority of the population (see the supporting document Quantifying public health risk
in the WHO Guidelines for drinking-water quality; Annex 1). This considerable difference in disease burden results in far stricter treatment requirements in low-income
regions for the same raw water quality in order to obtain the same risk (expressed as
DALYs per person per year). Ideally, the health outcome target of 106 DALY per person per year in Table 7.4 should be adapted to specific national situations. In Table 7.4,
no accounting is made for effects on immunocompromised persons (e.g. cryptosporidiosis in patients with human immunodeficiency virus or AIDS), which is significant
in some countries. Section 3.2 gives more information on the DALY metric and how it
is applied to derive a reference level of risk.
Only a proportion of the population may be susceptible to some pathogens, because immunity developed after an initial episode of infection or illness may provide
lifelong protection. Examples include hepatitis A virus and rotaviruses. It is estimated
that in developing countries, all children above the age of 5 years are immune to rotaviruses because of repeated exposure in the first years of life. This translates to an
average of 17% of the population being susceptible to rotavirus illness. In developed
countries, rotavirus infection is also common in the first years of life, and the illness is
diagnosed mainly in young children, but the percentage of young children as part of
the total population is lower. This translates to an average of 6% of the population in
developed countries being susceptible.
The uncertainty of the risk outcome is the result of the uncertainty and variability of the data collected in the various steps of the risk assessment. Risk assessment
models should ideally account for this variability and uncertainty, although here we
present only point estimates (see below).
It is important to choose the most appropriate point estimate for each of the
variables. Theoretical considerations show that risks are directly proportional to the
arithmetic mean of the ingested dose. Hence, arithmetic means of variables such as
concentration in raw water, removal by treatment and consumption of drinking-water
are recommended. This recommendation is different from the usual practice among
microbiologists and engineers of converting concentrations and treatment effects to
log values and making calculations or specifications on the log scale. Such calculations result in estimates of the geometric mean rather than the arithmetic mean, and
these may significantly underestimate risk. Analysing site-specific data may therefore
require going back to the raw data (i.e. counts and tested volumes) rather than relying
on reported log-transformed values, as these introduce ambiguity.
7.2.4 Risk-based performance target setting
The process outlined above enables estimation of risk on a population level, taking
account of raw water quality and impact of control. This can be compared with the
131
Table 7.4 Linking tolerable disease burden and raw water quality for reference pathogens:
example calculation
River water (human and
livestock pollution)
Units
100
10
5.89
5.98
5.96
1.3 105
1.05 104
1.1 105
1.3 105
1.05 104
1.1 105
Doseresponse (r)b
Probability of infection
per organism
2.0 101
1.9 102
5.9 101
Per day
2.6 106
2.0 106
6.5 106
Per year
9.5 10
7.3 10
2.4 103
Probability of illness
per infection
0.7
0.3
0.5
Per year
6.7 104
2.2 104
1.2 103
1.5 103
4.6 103
1.4 102
Percentage of
population
100
100
1 106
1 106
1 106
CD = CR 10PT
Pinf,d = E r
E = CD V
HT = Pill db fs 100
reference level of risk (see section 3.2) or a locally developed tolerable risk. The calculations enable quantification of the degree of source protection or treatment that
is needed to achieve a specified level of tolerable risk and analysis of the estimated
impact of changes in control measures.
Performance targets are most frequently applied to treatment performancethat
is, to determine the microbial reduction necessary to ensure water safety. A performance target may be applied to a specific system (i.e. formulated in response to local raw
water characteristics) or generalized (e.g. formulated in response to raw water quality
assumptions based on a certain type of source) (see also the supporting document
Water treatment and pathogen control; Annex 1).
132
7. MICROBIAL ASPECTS
Figure 7.2 Performance targets for example bacterial, viral and protozoan pathogens in relation to
raw water quality (to achieve 106 DALY per person per year)
Figure 7.2 illustrates the targets for treatment performance for a range of pathogens occurring in raw water. For example, 10 microorganisms per litre of raw water will
lead to a performance target of 5.89 logs (or 99.999 87% reduction) for Cryptosporidium or of 5.96 logs (99.999 89% reduction) for rotaviruses in high-income regions
to achieve 106 DALY per person per year (see also Table 7.5 below). The difference in
performance targets for rotaviruses in high- and low-income countries (5.96 and 7.96
logs; Figure 7.2) is related to the difference in disease severity caused by this organism.
In low-income countries, the child case fatality rate is relatively high, and, as a consequence, the disease burden is higher. Also, a larger proportion of the population in
low-income countries is under the age of 5 and at risk for rotavirus infection.
The derivation of these performance targets is described in Table 7.5, which
provides an example of the data and calculations that would normally be used to
construct a risk assessment model for waterborne pathogens. The table presents data
for representatives of the three major groups of pathogens (bacteria, viruses and
protozoa) from a range of sources. These example calculations aim at achieving the
reference level of risk of 106 DALY per person per year, as described in section 3.2.
The data in the table illustrate the calculations needed to arrive at a risk estimate and
are not guideline values.
7.2.5 Presenting the outcome of performance target development
Table 7.5 presents some data from Table 7.4 in a format that is more meaningful to risk
managers. The average concentration of pathogens in drinking-water is included for
information. It is not a water quality target, nor is it intended to encourage pathogen
monitoring in finished water. As an example, a concentration of 1.3 105 Cryptosporidium per litre (see Table 7.4) corresponds to 1 oocyst per 79 000 litres (see Table 7.5).
The performance target (in the row Treatment effect in Table 7.4), expressed as a
133
Table 7.5 Health-based targets derived from example calculation in Table 7.4
Cryptosporidium
Organisms per litre in raw water 10
Campylobacter
Rotavirusa
100
10
10 DALY per person 10 DALY per person 106 DALY per person
per year
per year
per year
Drinking-water quality
Performance target
Data from high-income regions. In low-income regions, severity is typically higher, but drinking-water transmission is
unlikely to dominate.
b
For the susceptible population.
c
Performance target is a measure of log reduction of pathogens based on raw water quality.
a
log10 reduction value, is the most important management information in the risk assessment table. It can also be expressed as a per cent reduction. For example, a 5.96
log10 unit reduction for rotaviruses corresponds to a 99.999 89% reduction.
7.2.6 Adapting risk-based performance target setting to local circumstances
The reference pathogens illustrated in the previous sections will not be priority pathogens in all regions of the world. Wherever possible, country- or site-specific information should be used in assessments of this type. If no specific data are available, an
approximate risk estimate can be based on default values (see Table 7.6 below).
Table 7.5 accounts only for changes in water quality derived from treatment and
not from source protection measures, which are often important contributors to overall safety, affecting pathogen concentration and/or variability. The risk estimates presented in Table 7.4 also assume that there is no degradation of water quality in the
distribution network. These may not be realistic assumptions under all circumstances,
and it is advisable to take these factors into account wherever possible.
Table 7.5 presents point estimates only and does not account for variability and
uncertainty. Full risk assessment models would incorporate such factors by representing the input variables by statistical distributions rather than by point estimates.
However, such models are currently beyond the means of many countries, and data
to define such distributions are scarce. Producing such data may involve considerable
efforts in terms of time and resources, but will lead to much improved insight into the
actual raw water quality and treatment performance.
The necessary degree of treatment also depends on the values assumed for variables that can be taken into account in the risk assessment model. One such variable is drinking-water consumption. Figure 7.3 shows the effect of variation in the
consumption of unboiled drinking-water on the performance targets for Cryptosporidium. If the raw water concentration is 1 oocyst per litre, the performance target
varies between 4.3 and 5.2 log10 units if consumption values vary between 0.25 and
2 litres per day. Another variable is the fraction of the population that is susceptible.
Some outbreak data suggest that in developed countries, a significant proportion of
the population above 5 years of age may not be immune to rotavirus illness. Figure 7.4
134
7. MICROBIAL ASPECTS
Cryptosporidium
Performance target (log10 reduction)
9
1 litre
8
7
0.25 litre
2 litres
6
5
4
3
2
1
0
0.001
0.01
0.1
10
100
1000
6% susceptible
8
7
20% susceptible
100% susceptible
6
5
4
3
2
1
0
0.001
0.01
0.1
10
100
1000
Figure 7.4 Performance targets for rotaviruses in relation to the fraction of the population that
is susceptible to illness (to achieve 106 DALY per person per year)
shows the effect of variation in the susceptible fraction of the population. If the raw
water concentration is 10 rotavirus particles per litre, the performance target increases
from 5.96 to 7.18 as the susceptible fraction increases from 6% to 100%.
7.2.7 Health outcome targets
Health outcome targets that identify disease reductions in a community should be
responded to by the control measures set out in water safety plans and associated
135
Table 7.6 Example occurrence of selected indicators and pathogens in faeces, wastewater and
raw water (local data will vary)
Microbe
1061010
100100 000
Campylobacter spp.
106
100106
10010 000
Vibrio cholerae
10
100106
100108
Enteroviruses
10
11000
0.0110
Rotaviruses
109
505000
0.01100
Cryptosporidium
10
110 000
01000
Giardia intestinalis
107
110 000
01000
water quality interventions at community and household levels. These targets would
identify expected disease reductions in communities receiving the interventions.
The prioritization of water quality interventions should focus on those aspects
that are estimated to contribute more than, for example, 5% of the burden of a given
disease (e.g. 5% of total diarrhoea). In many parts of the world, the implementation of
a water quality intervention that results in an estimated health gain of more than 5%
would be considered extremely worthwhile. Directly demonstrating the health gains
arising from improving water qualityas assessed, for example, by reduced E. coli
counts at the point of consumptionmay be possible where disease burden is high
and effective interventions are applied and can be a powerful tool to demonstrate a
first step in incremental drinking-water safety improvement.
Where a specified quantified disease reduction is identified as a health outcome
target, it is advisable to undertake ongoing proactive public health surveillance among
representative communities to measure the effectiveness of water quality interventions.
7. MICROBIAL ASPECTS
over a period of time, taking care to include consideration of seasonal variation and
peak events such as storms. Direct measurement of pathogens and indicator organisms
in the specific source waters for which a water safety plan and its target pathogens are
being established is recommended wherever possible, because this provides the best
estimates of microbial concentrations. However, resource limitations in many settings
preclude this. In the absence of measured pathogen concentrations, an alternative interim approach is to make estimations based on available data, such as the results of
sanitary surveys combined with indicator testing.
In the case of absence of data on the occurrence and distribution of human pathogens in water for the community or area of implementation, concentrations in raw
waters can be inferred from observational data on numbers of pathogens per gram
of faeces representing direct faecal contamination or from numbers of pathogens per
litre of untreated wastewater (Table 7.6). Data from sanitary surveys can be used to
estimate the impact of raw or treated wastewater discharged into source waters. In
treated wastewater, the concentrations of pathogens may be reduced 10- to 100-fold
or more, depending on the efficiency of the treatment process. The concentrations
of pathogens in raw waters can be estimated from concentrations of pathogens in
wastewater and the fraction of wastewater present in source waters. In addition, some
indicative concentrations of pathogens in source waters are given that were measured
at specific locations, but these concentrations may differ widely between locations.
From Table 7.6, it may be clear that faecal indicator bacteria, such as E. coli, are
always present at high concentrations in wastewater. Everybody sheds E. coli; nevertheless, concentrations vary widely. Only infected persons shed pathogens; therefore,
the concentrations of pathogens in wastewater vary even more. Such variations are
due to shedding patterns, but they also depend on other factors, such as the size of the
population discharging into wastewater and dilution with other types of wastewater,
such as industrial wastewater. Conventional wastewater treatment commonly reduces
microbial concentrations by one or two orders of magnitude before the wastewater is
discharged into surface waters. At other locations, raw wastewater may be discharged
directly, or discharges may occur occasionally during combined sewer overflows. Discharged wastewater is diluted in receiving surface waters, leading to reduced pathogen
numbers, with the dilution factor being very location specific. Pathogen inactivation,
die-off or partitioning to sediments may also play a role in pathogen reduction. These
factors differ with the surface water body and climate. This variability suggests that
concentrations of faecal indicators and pathogens vary even more in surface water
than in wastewater.
Because of differences in survival, the ratio of pathogen to E. coli at the point of discharge will not be the same as farther downstream. A comparison of data on E. coli with
pathogen concentrations in surface waters indicates that, overall, there is a positive relationship between the presence of pathogens in surface water and E. coli concentration,
but that pathogen concentrations may vary widely from low to high at any E. coli concentration. Even the absence of E. coli is not a guarantee for the absence of pathogens or
for pathogen concentrations to be below those of significance for public health.
The estimates based on field data in Table 7.6 provide a useful guide to the concentrations of enteric pathogens in a variety of sources affected by faecal contamination.
137
However, there are a number of limitations and sources of uncertainty in these data,
including the following:
Although data on pathogens and E. coli were derived from different regions in the
world, they are by far mostly from high-income countries.
There are concerns about the sensitivity and robustness of analytical techniques,
particularly for viruses and protozoa, largely associated with the recoveries
achieved by techniques used to process and concentrate large sample volumes
typically used in testing for these organisms.
Numbers of pathogens were derived using a variety of methods, including culturebased methods using media or cells, molecular-based tests (such as polymerase
chain reaction) and microscopy, and should be interpreted with care.
The lack of knowledge about the infectivity of the pathogens for humans has
implications in risk assessment and should be addressed.
7.3.2 Treatment
Understanding the efficacy of control measures includes validation (see sections 2.2
and 4.1.7). Validation is important both in ensuring that treatment will achieve the
desired goals (performance targets) and in assessing areas in which efficacy may be
improved (e.g. by comparing performance achieved with that shown to be achievable
through well-run processes). Water treatment could be applied in a drinking-water
treatment plant (central treatment) to piped systems or in the home or at the point of
use in settings other than piped supplies.
Central treatment
Waters of very high quality, such as groundwater from confined aquifers, may rely on
protection of the source water and the distribution system as the principal control
measures for provision of safe water. More typically, water treatment is required to remove or destroy pathogenic microorganisms. In many cases (e.g. poor quality surface
water), multiple treatment stages are required, including, for example, coagulation,
flocculation, sedimentation, filtration and disinfection. Table 7.7 provides a summary
of treatment processes that are commonly used individually or in combination to
achieve microbial reductions (see also Annex 5). The minimum and maximum removals are indicated as log10 reduction values and may occur under failing and optimal
treatment conditions, respectively.
The microbial reductions presented in Table 7.7 are for broad groups or categories of microbes: bacteria, viruses and protozoa. This is because it is generally the case
that treatment efficacy for microbial reduction differs among these microbial groups
as a result of the inherently different properties of the microbes (e.g. size, nature of
protective outer layers, physicochemical surface properties). Within these microbial
groups, differences in treatment process efficiencies are smaller among the specific
species, types or strains of microbes. Such differences do occur, however, and the table
presents conservative estimates of microbial reductions based on the more resistant or
persistent pathogenic members of that microbial group. Where differences in removal
by treatment between specific members of a microbial group are great, the results for
the individual microbes are presented separately in the table.
138
7. MICROBIAL ASPECTS
Table 7.7 Reductions of bacteria, viruses and protozoa achieved by water treatment
technologies at drinking-water treatment plants for large communities
Treatment process
Enteric
Minimum Maximum
pathogen removal removal
group
(LRV)
(LRV)
Notes
Pretreatment
Roughing filters
Bacteria
0.2
2.3
Storage reservoirs
Bacteria
0.7
2.2
Protozoa
1.4
2.3
8.3
Bank filtration
Viruses
> 2.1
Bacteria
>6
>1
>2
Protozoa
Viruses
0.1
3.4
Bacteria
0.2
Protozoa
High-rate clarification
Protozoa
>2
2.8
Protozoa
0.6
2.6
Lime softening
Viruses
Bacteria
Protozoa
Viruses
3.5
Bacteria
0.2
4.4
Protozoa
0.4
3.3
Viruses
0.25
Bacteria
Protozoa
0.3
Viruses
1.7
Bacteria
0.2
2.3
Protozoa
6.7
<1
> 6.5
Filtration
Granular high-rate
filtration
Precoat filtration
Membrane filtration:
microfiltration,
ultrafiltration,
nanofiltration
reverse osmosis
Viruses
>5
Bacteria
>7
Protozoa
2.3
>7
139
Depends on presence of
schmutzdecke, grain size, flow
rate, operating conditions (mainly
temperature, pH)
Treatment process
Enteric
Minimum Maximum
pathogen removal removal
group
(LRV)
(LRV)
Notes
Primary disinfectiona,b
Chlorine
Viruses
Bacteria
Protozoa
Chlorine dioxide
Viruses
Bacteria
Ozone
UV
Protozoa
Viruses
2 (Ct99 0.0060.2
minmg/l)
Bacteria
Protozoa
2 (Ct99 0.540
minmg/l)
Viruses
4 (7186 mJ/cm2)
Bacteria
4 (0.65230 mJ/cm )
Protozoa
Depends on temperature;
Cryptosporidium varies widely
Ct, product of disinfectant concentration and contact time; LRV, log10 reduction value
a
Chemical disinfection: Ct values are given that achieve 2 LRV.
b
UV irradiation: UV dose range is given that achieves 4 LRV.
Sources: Chevrefils et al. (2006); Dullemont et al. (2006); Hijnen, Beerendonk & Medema (2006); see also the supporting
document Water treatment and pathogen control (Annex 1).
Further information about these water treatment processes, their operations and
their performance for pathogen reduction in piped water supplies is provided in more
detail in the supporting document Water treatment and pathogen control (Annex 1).
Household treatment
Household water treatment technologies are any of a range of devices or methods
employed for the purposes of treating water in the home or at the point of use in
other settings. These are also known as point-of-use or point-of-entry water treatment
technologies (Cotruvo & Sobsey, 2006; Nath, Bloomfield & Jones, 2006; see also the
supporting document Managing water in the home, Annex 1). Household water treatment technologies comprise a range of options that enable individuals and communities
to treat collected water or contaminated piped water to remove or inactivate microbial
140
7. MICROBIAL ASPECTS
pathogens. Many of these methods are coupled with safe storage of the treated water
to preclude or minimize contamination after household treatment (Wright, Gundry &
Conroy, 2003).
Household water treatment and safe storage have been shown to significantly
improve water quality and reduce waterborne infectious disease risks (Fewtrell & Colford, 2004; Clasen et al., 2006). Household water treatment approaches have the potential to have rapid and significant positive health impacts in situations where piped
water systems are not possible and where people rely on source water that may be
contaminated or where stored water becomes contaminated because of unhygienic
handling during transport or in the home. Household water treatment can also be
used to overcome the widespread problem of microbially unsafe piped water supplies.
Similar small technologies can also be used by travellers in areas where the drinkingwater quality is uncertain (see also section 6.11).
Not all household water treatment technologies are highly effective in reducing
all classes of waterborne pathogens (bacteria, viruses, protozoa and helminths). For
example, chlorine is ineffective for inactivating oocysts of the waterborne protozoan
Cryptosporidium, whereas some filtration methods, such as ceramic and cloth or fibre
filters, are ineffective in removing enteric viruses. Therefore, careful consideration of
the health-based target microbes to control in a drinking-water source is needed when
choosing among these technologies.
Definitions and descriptions of the various household water treatment
technologies for microbial contamination follow:
in the document Preventing travellers diarrhoea: How to make drinking water safe
(WHO, 2005).
Disinfection of drinking-water with iodine, which is also a strong oxidant, is
generally not recommended for extended use unless the residual concentrations
are controlled, because of concerns about adverse effects of excess intake on the
thyroid gland; however, this issue is being re-examined, because dietary iodine
deficiency is a serious health problem in many parts of the world (see also section 6.11 and Table 6.1). As for central treatment, ozone for household water
treatment must be generated on site, typically by corona discharge or electrolytically, both of which require electricity. As a result, ozone is not recommended for
household water treatment because of the need for a reliable source of electricity
to generate it, its complexity of generation and proper dosing in a small application, and its relatively high cost. Strong acids or bases are not recommended as
chemical disinfectants for drinking-water, as they are hazardous chemicals that
can alter the pH of the water to dangerously low or high levels. However, as an
emergency or short-term intervention, the juices of some citrus fruits, such as
limes and lemons, can be added to water to inactivate Vibrio cholerae, if enough is
added to sufficiently lower the pH of the water (probably to pH less than 4.5).
Membrane, porous ceramic or composite filters: These are filters with defined pore
sizes and include carbon block filters, porous ceramics containing colloidal silver,
reactive membranes, polymeric membranes and fibre/cloth filters. They rely on
physical straining through a single porous surface or multiple surfaces having
structured pores to physically remove and retain microbes by size exclusion. Some
of these filters may also employ chemical antimicrobial or bacteriostatic surfaces
or chemical modifications to cause microbes to become adsorbed to filter media
surfaces, to be inactivated or at least to not multiply. Cloth filters, such as those of
sari cloth, have been recommended for reducing Vibrio cholerae in water. However,
these filters reduce only vibrios associated with copepods, other large crustaceans
or other large eukaryotes retained by the cloth. These cloths will not retain dispersed vibrios or other bacteria not associated with copepods, other crustaceans,
suspended sediment or large eukaryotes, because the pores of the cloth fabric are
much larger than the bacteria, allowing them to pass through. Most household
filter technologies operate by gravity flow or by water pressure provided from a
piped supply. However, some forms of ultrafiltration, nanofiltration and reverse
osmosis filtration may require a reliable supply of electricity to operate.
Granular media filters: Granular media filters include those containing sand or
diatomaceous earth or others using discrete particles as packed beds or layers
of surfaces over or through which water is passed. These filters retain microbes
by a combination of physical and chemical processes, including physical straining, sedimentation and adsorption. Some may also employ chemically active
antimicrobial or bacteriostatic surfaces or other chemical modifications. Other
granular media filters are biologically active because they develop layers of microbes and their associated exopolymers on the surface of or within the granular
medium matrix. This biologically active layer, called the schmutzdecke in conventional slow sand filters, retains microbes and often leads to their inactivation and
142
7. MICROBIAL ASPECTS
7. MICROBIAL ASPECTS
Table 7.8 Reductions of bacteria, viruses and protozoa achieved by household water
treatment technologies
Treatment process
Enteric
pathogen
group
Baseline Maximum
removal removal
(LRV)
(LRV)
Notes
Chemical disinfection
Free chlorine
disinfection
Bacteria
Viruses
Protozoa,
non-Cryptosporidium
Cryptosporidium
Membrane filtration
(microfiltration,
ultrafiltration,
nanofiltration, reverse
osmosis)
Bacteria
Viruses
Protozoa
Bacteria
Viruses
Protozoa
Bacteria
Viruses
Protozoa
Rapid granular,
Bacteria
diatomaceous earth,
Viruses
biomass and fossil
fuelbased (granular
Protozoa
and powdered activated
carbon, wood and
charcoal ash, burnt rice
hulls, etc.) filters
4+
4+
4+
Household-level
Bacteria
intermittently operated
Viruses
slow sand filtration
Protozoa
0.5
145
Treatment process
Enteric
pathogen
group
Baseline Maximum
removal removal
(LRV)
(LRV)
Notes
Solar disinfection
Solar disinfection (solar Bacteria
UV radiation + thermal
Viruses
effects)
Protozoa
5+
4+
4+
5+
Bacteria
Viruses
5+
Protozoa
5+
9+
Bacteria
Viruses
9+
Protozoa
9+
Bacteria
0.5
Viruses
0.5
Protozoa
4.5
Sedimentation
Simple sedimentation
LRV, log10 reduction value; MF, microfilter; NF, nanofilter; RO, reverse osmosis; UF, ultrafilter
7. MICROBIAL ASPECTS
and other point-of-use and point-of-entry drinking-water supplies and their treatment and storage technologies, just as they are for central systems (see sections 2.3
and 5.2.3).
Non-piped water treatment technologies manufactured by or obtained from
commercial or other external sources should be certified to meet performance or effectiveness requirements or guidelines, preferably by an independent, accredited certification body. If the treatment technologies are locally made and managed by the
household itself, efforts to document effective construction and use and to monitor
performance during use are recommended and encouraged.
Owing to issues relating to complexity, sensitivity of detection, cost and timeliness of obtaining results, testing for specific pathogens is generally limited to assessing
raw water quality as a basis for identifying performance targets and validation, where
monitoring is used to determine whether a treatment or other process is effective in
removing target organisms. Very occasionally, pathogen testing may be performed to
verify that a specific treatment or process has been effective. However, microbial testing included in verification, operational and surveillance monitoring is usually limited
to testing for indicator organisms.
It is important to recognize that different methods for pathogen detection measure
different properties. Culture methods, such as broth cultures or agar-based bacterial
media and cell cultures for viruses and phages, detect living organisms based on infection or growth. Pathogen detection by microscopy, nucleic acid presence or amplification (e.g. polymerase chain reaction) and immunological assays (e.g. enzyme-linked
immunosorbent assay) measure the physical presence of the pathogen or components
of them and do not necessarily determine if what is detected is alive or infectious. This
creates greater uncertainty regarding the human health risk significance compared
with detection by culture-based methods. When using non-culture methods that do
not measure in units indicative of culturability or infectivity, assumptions are often
made about the fraction of pathogens or components detected that represent viable
and infectious organisms.
The concept of using organisms such as E. coli as indicators of faecal pollution is a
well-established practice in the assessment of drinking-water quality. The criteria determined for such faecal indicators are that they should not be pathogens themselves
and they should:
147
a
b
Microorganism(s)
Validation of process
Operational
Verification and
surveillance
E. coli (or
thermotolerant
coliforms)
Not applicable
Not applicable
Faecal indicator
Total coliforms
Not applicable
Heterotrophic plate
counts
Clostridium
perfringensa
Not applicableb
Coliphages
Bacteroides fragilis
phages
Enteric viruses
Not applicableb
Not applicable
Use of Clostridium perfringens for validation will depend on the treatment process being assessed.
Could be used for verification where source waters are known to be contaminated with enteric viruses and protozoa
or where such contamination is suspected as a result of impacts of human faecal waste.
These criteria reflect an assumption that the same organism could be used as an indicator of both faecal pollution and treatment/process efficacy. However, it has become
clear that one indicator cannot fulfil these two roles and that a range of organisms
should be considered for different purposes (Table 7.9). For example, heterotrophic
bacteria can be used as operational indicators of disinfection effectiveness and distribution system cleanliness; Clostridium perfringens and coliphage can be used to
validate the effectiveness of treatment systems.
Escherichia coli has traditionally been used to monitor drinking-water quality,
and it remains an important parameter in monitoring undertaken as part of verification or surveillance. Thermotolerant coliforms can be used as an alternative to the test
for E. coli in many circumstances. Water intended for human consumption should
contain no faecal indicator organisms. In the majority of cases, monitoring for E. coli
or thermotolerant coliforms provides a high degree of assurance because of their large
numbers in polluted waters.
148
7. MICROBIAL ASPECTS
Table 7.10 Guideline values for verification of microbial qualitya (see also Table 5.2)
Organisms
Guideline value
However, increased attention has focused on the shortcomings of traditional indicators, such as E. coli, as indicator organisms for enteric viruses and protozoa. Viruses
and protozoa more resistant to conventional environmental conditions or treatment
technologies, including filtration and disinfection, may be present in treated drinkingwater in the absence of E. coli. Retrospective studies of waterborne disease outbreaks
have shown that complete reliance on assumptions surrounding the absence or presence
of E. coli may not ensure safety. Under certain circumstances, it may be desirable to include more resistant microorganisms, such as bacteriophages and/or bacterial spores, as
indicators of persistent microbial hazards. Their inclusion in monitoring programmes,
including control and surveillance programmes, should be evaluated in relation to local
circumstances and scientific understanding. Such circumstances could include the use of
source water known to be contaminated with enteric viruses and parasites or where such
contamination is suspected as a result of the impacts of human and livestock waste.
Further discussion on indicator organisms is contained in the supporting
document Assessing microbial safety of drinking water (Annex 1).
Table 7.10 presents guideline values for verification of the microbial quality of
drinking-water. Individual values should not be used directly from the table. The
guideline values should be used and interpreted in conjunction with the information
contained in these Guidelines and other supporting documentation.
A consequence of variable susceptibility to pathogens is that exposure to
drinking-water of a particular quality may lead to different health effects in different
populations. For derivation of national standards, it is necessary to define reference
populations or, in some cases, to focus on specific vulnerable subpopulations. National or local authorities may wish to apply specific characteristics of their populations in
deriving national standards.
149
Table 7.11 International Organization for Standardization (ISO) standards for detection and
enumeration of faecal indicator organisms in water
ISO standard Title (water quality)
6461-1:1986
6461-2:1986
7704:1985
9308-1:2000
9308-2:1990
9308-3:1998
7. MICROBIAL ASPECTS
Protocols should identify mechanisms for the communication of boil water advisories. The mechanisms may vary, depending on the nature of the supply and the
size of the community affected, and could include:
The methods chosen should provide a reasonable surety that all of those affected by the
advisory, including residents, workers and travellers, are notified as soon as possible.
Boil water advisories should indicate that the water can be made safe by bringing it
to a rolling boil. After boiling, the water should be allowed to cool down on its own without the addition of ice. This procedure is effective at all altitudes and with turbid water.
The types of event that should lead to consideration of boil water advisories include:
Boil water advisories are a serious measure that can have substantial adverse consequences. Advice to boil water can have negative public health consequences through
scalding and increased anxiety, even after the advice is rescinded. In addition, not all
consumers will follow the advice issued, even at the outset; if boil water advisories are
issued frequently or are left in place for long periods, compliance will decrease. Hence,
advisories should be issued only after careful consideration of all available information by the public health authority and the incident response team and conclusion
that there is an ongoing risk to public health that outweighs any risk from the advice to boil water. For example, where microbial contamination is detected in samples
of drinking-water, factors that should be considered in evaluating the need for an
advisory include:
The available information should be reviewed to determine the likely source of the
contamination and the likelihood of recurrence or persistence.
When issued, a boil water advisory should be clear and easily understood by recipients, or it may be ignored. Advisories should normally include a description of the
problem, potential health risks and symptoms, activities that are affected, investigative
actions and corrective measures that have been initiated, as well as the expected time
to resolve the problem. If the advisory is related to an outbreak of illness, specific information should be provided on the nature of the outbreak, the illness and the public
health response.
Boil water advisories should identify both affected and unaffected uses of
drinking-water supplies. Generally, the advisory will indicate that unboiled water
should not be used for drinking, preparing cold drinks, making ice, preparing or washing food or brushing teeth. Unless heavily contaminated, unboiled water will generally
be safe for bathing (providing swallowing of water is avoided) and washing clothes. A
boil water advisory could include specific advice for vulnerable subpopulations, such
as pregnant women and others who might be immunocompromised. Specific advice
should also be provided to facilities such as dental clinics, dialysis centres, doctors
offices, hospitals and other health-care facilities, child-care facilities, schools, food suppliers and manufacturers, hotels, restaurants and operators of public swimming pools
and spas.
152
7. MICROBIAL ASPECTS
153
8
Chemical aspects
Introduction
(Chapter 1)
155
Fact sheets for individual chemical contaminants are provided in chapter 12. For
those contaminants for which a guideline value has been established, the fact sheets
include a brief toxicological overview of the chemical, the basis for guideline derivation, treatment performance and analytical limit of detection. More detailed chemical
reviews are available (http://www.who.int/water_sanitation_health/dwq/chemicals/
en/index.html).
8. Chemical aspects
157
Examples of sources
Naturally occurring
Categories may not always be clear-cut. The group of naturally occurring contaminants, for example, includes many inorganic chemicals that are found in drinking-water as a consequence of release from rocks and soils by rainfall, some of which
may become problematical where there is environmental disturbance, such as in mining areas.
There is credible evidence of occurrence of the chemical in drinking-water, combined with evidence of actual or potential toxicity.
The chemical is of significant international concern.
The chemical is being considered for inclusion or is included in the World Health
Organization Pesticide Evaluation Scheme (WHOPES), which coordinates the
testing and evaluation of pesticides for public health, including those applied directly to drinking-water for control of insect vectors of disease.
8. Chemical aspects
phase of developing a water safety plan, a health-based value has been determined.
Establishing a formal guideline value for such substances could encourage some Member States to incorporate a value into their national standards when this is neither necessary nor appropriate.
There are two principal sources of information on health effects resulting from
exposure to chemicals that can be used in deriving guideline values. The first and
preferred source is studies on human populations. However, the availability of such
studies for most substances is limited, owing to the ethical barriers to conducting human toxicological studies and the lack of quantitative information on the concentration to which people have been exposed or on simultaneous exposure to other agents.
However, for a few substances, such studies are the primary basis on which guideline
values are developed. The second and most frequently used source of information is
toxicological studies using laboratory animals. The limitations of toxicological studies
include the relatively small number of experimental animals used and the relatively
high doses administered, which create uncertainty as to the relevance of particular
findings to human health. This uncertainty stems from the need to extrapolate the
results from experimental animals to humans and to the low doses to which human
populations are usually exposed. In most cases, the study used to derive the guideline
value is supported by a range of other studies, including human data, and these are
also considered in carrying out a health risk assessment.
In order to derive a guideline value to protect human health, it is necessary to
select the most suitable study or studies. Data from well-conducted studies, where a
clear doseresponse relationship has been demonstrated, are preferred. Expert judgement, applied against criteria described in section 8.2.4, is exercised in the selection
of the most appropriate studies from the range of information available. Safety or
uncertainty factors using standard risk assessment principles are included to provide
conservative guideline values that are considered to be protective.
8.2.1 Approaches taken
Two approaches to the derivation of guideline values are used: one for threshold
chemicals and the other for non-threshold chemicals (mostly genotoxic carcinogens).
It is generally considered that the initiating event in the process of genotoxic
chemical carcinogenesis is the induction of a mutation in the genetic material (deoxyribonucleic acid [DNA]) of somatic cells (i.e. cells other than ova or sperm) and
that there is a theoretical risk at any level of exposure (i.e. no threshold). In contrast,
there are carcinogens that are capable of producing tumours in experimental animals or humans without exerting a genotoxic activity, but acting through an indirect
mechanism. It is generally believed that a demonstrable threshold dose exists for nongenotoxic carcinogens.
In deriving guideline values for carcinogens, consideration is given to the
potential mechanisms by which the substance may cause cancer, in order to decide
whether a threshold or non-threshold approach should be used (see sections 8.2.2
and 8.2.3).
159
where:
NOAEL
LOAEL
BMDL
UF
CSAF
=
=
=
=
=
no-observed-adverse-effect level
lowest-observed-adverse-effect level
lower confidence limit on the benchmark dose
uncertainty factor
chemical-specific adjustment factor
The guideline value (GV) is then derived from the TDI as follows:
GV
TDI bw P
C
where:
bw
P
C
160
8. Chemical aspects
Source of uncertainty
Interspecies variation (extrapolating from experimental animals to humans)
Intraspecies variation (accounting for individual variations within humans)
Adequacy of studies or database
Nature and severity of effect
110
110
110
110
roduces a small increase (e.g. 5% or 10%) in the level of adverse effects. The BMDL
p
is derived on a quantitative basis using data from the entire doseresponse curve for
the critical effect rather than from a single dose at the NOAEL or LOAEL and accounts
for the statistical power and quality of the data (IPCS, 2009).
Uncertainty factors
The application of uncertainty or safety factors has been traditionally and successfully
used in the derivation of ADIs and TDIs for food additives, pesticides and environmental contaminants. The derivation of these factors requires expert judgement and
careful consideration of the available scientific evidence.
In the derivation of guideline values, uncertainty factors are applied to the
NOAEL, LOAEL or BMD/BMDL for the response considered to be the most biologically significant.
In relation to exposure of the general population, the NOAEL or BMD/BMDL for
the critical effect in experimental animals is normally divided by an uncertainty factor
of 100. This comprises two 10-fold factors, one for interspecies differences and one
for interindividual variability in humans (Table 8.2). Extra uncertainty factors may be
incorporated to allow for database deficiencies and for the severity or irreversibility
of effects.
Factors lower than 10 are used, for example, for interspecies variation when humans are known to be less sensitive than the experimental animal species studied.
Inadequate studies or databases include those where a LOAEL is used instead of a
NOAEL and studies considered to be shorter in duration than desirable. Situations
in which the nature or severity of effect might warrant an additional uncertainty factor include studies in which the end-point is malformation of a fetus or in which
the end-point determining the NOAEL is directly related to possible carcinogenicity.
In the latter case, an additional uncertainty factor is usually applied for carcinogenic
compounds for which the guideline value is derived using a TDI approach rather than
a theoretical risk extrapolation approach.
For substances for which the uncertainty factors are greater than 1000, guideline
values are designated as provisional in order to emphasize the higher level of uncertainty inherent in these values. A high uncertainty factor indicates that the guideline
value may be considerably lower than the concentration at which health effects would
actually occur in a real human population. Guideline values with high uncertainty are
more likely to be modified as new information becomes available.
The selection and application of uncertainty factors are important in the derivation of guideline values for chemicals, as they can make a considerable difference in the
162
8. Chemical aspects
values set. For contaminants for which there is sufficient confidence in the database,
the guideline value is derived using a small uncertainty factor. For most contaminants,
however, there is greater scientific uncertainty, and a relatively large uncertainty factor
is used. The use of uncertainty factors enables the particular attributes of the chemical
and the data available to be considered in the derivation of guideline values.
Use of chemical-specific adjustment factors instead of uncertainty factors
Approaches to the derivation of TDIs are increasingly being based on understanding
of a chemicals mode of action in order to reduce reliance on default assumptions.
This approach provides a departure from the use of default uncertainty factors (such
as a simple 10 for interspecies variation and 10 for intraspecies variation) and relies
on the use of quantitative toxicokinetic and toxicodynamic data to derive CSAFs for
use in interspecies and intraspecies extrapolations (IPCS, 2005). Previously, CSAFs
were called data-derived uncertainty factors. The part of the CSAF approach that is
at present best developed is the use of physiologically based pharmacokinetic models
to replace the default values for extrapolation between species and between differing
routes of exposure (e.g. inhalation to oral).
Relative source allocation
Drinking-water is usually not the only source of human exposure to the chemicals
for which guideline values have been derived. In many cases, the exposure to or intake of chemical contaminants from drinking-water is much lower than that from
other sources, such as food, air and consumer products. Some consideration of the
proportion of the ADI or TDI that may be attributed to different sources is therefore
needed in developing guideline values and risk management strategies. This approach
ensures that total daily intake from all sources (including drinking-water containing
concentrations of the chemical at or near the guideline value) does not exceed the ADI
or TDI.
Wherever possible, data on the proportion of total daily intake normally ingested
in drinking-water (based on mean levels in food, drinking-water and air) or intakes
estimated on the basis of physical and chemical properties of the substances of concern are used in the derivation of guideline values. As the primary sources of exposure
to chemicals are generally food (e.g. pesticide residues) and water, it is important to
quantify the exposures from both sources. To inform this process, it is desirable to
collect as many high-quality data on food intake in different parts of the world as possible. The data collected can then be used to estimate the proportion of the intake that
comes from food and the proportion that comes from drinking-water.
Where appropriate information on exposure from food and water is not available, allocation factors are applied that reflect the likely contribution of water to
total daily intake for various chemicals. In the absence of adequate exposure data,
the normal allocation of the total daily intake to drinking-water is 20%, which reflects a reasonable level of exposure based on broad experience, while still being
protective. This value reflects a change from the previous allocation of 10%, which
was found to be excessively conservative. As chemicals are progressively reassessed,
overall exposure will be reconsidered, and a change in the default allocation factor
163
from 10% to 20% will be made, if appropriate. Therefore, not all older guideline
values in this edition will reflect this change. In some circumstances, there is clear
evidence that exposure from food is very low, such as for some of the DBPs; the allocation in such cases may be as high as 80%, which still allows for some exposure
from other sources. In the case of some pesticides, which are likely to be found as
residues in food from which there will be significant exposure, the allocation for
water may be as low as 1%.
A detailed explanation of the reasoning behind the choice of allocation factor is
an essential component of the evaluation. This assists Member States in making appropriate decisions about incorporating or adapting guideline values into national
standards where local circumstances need to be taken into account. It also provides
assistance in making decisions regarding potential risks when a guideline value is exceeded. As a general principle, efforts should be made to keep contaminant concentrations as low as possible and not allow increases up to the guideline value.
Although the values chosen are, in most cases, sufficient to account for additional
routes of intake (i.e. inhalation and dermal absorption) of contaminants in water,
under certain circumstances (e.g. limited ventilation), authorities may wish to take
inhalation and dermal exposure into account in adapting the guideline values to local
conditions (see section 8.2.9).
Some elements are essential for human nutrition. In developing guideline values
and in considering allocation factors, it is necessary to take into account the recommended minimum daily intake and exposures from food and to ensure that the allocation does not result in an apparent conflict with essentiality.
Default assumptions
There is variation in both the volume of water consumed daily and the body weight of
consumers. It is therefore necessary to apply some assumptions in order to determine
a guideline value. The default assumption for consumption by an adult is 2 litres of
water per day, whereas the default assumption for body weight is 60 kg.
In some cases, the guideline value is based on children, where they are considered
to be particularly vulnerable to a particular substance. In this event, a default intake
of 1litre is assumed for a body weight of 10 kg; where the most vulnerable group is
considered to be bottle-fed infants, an intake of 0.75 litre is assumed for a body weight
of 5 kg.
Significant figures
The calculated TDI is used to derive the guideline value, which is usually rounded
to one significant figure. In some instances, ADI values with only one significant figure set by JECFA or JMPR were used to calculate the guideline value. The guideline
value was generally rounded to one significant figure to reflect the uncertainty in,
for example, experimental animal toxicity data, exposure assumptions made and the
uncertainty factors selected. In a few cases, rounding to two significant figures was
found to be appropriate, as the impact of rounding depends on the units; for example,
rounding from 1.5 to 2.0 g/l has less influence on exposure than rounding from 1.5
to 2.0 mg/l. These are considered on a case-by-case basis.
164
8. Chemical aspects
The general rounding rule for mid-way values (x.5) is to round up, in line with
common convention. Examples for rounding to one significant figure are as follows:
1.25 becomes 1, 0.73 becomes 0.7 and 1.5 becomes 2.
8.2.3 Non-threshold chemicals
In the case of compounds considered to be genotoxic carcinogens, guideline values are
normally determined using a mathematical model. Although several models exist, the
linearized multistage model is generally adopted. Other models are considered more
appropriate in certain cases. These models compute an estimate of risk at a particular
level of exposure, along with upper and lower bounds of confidence on the calculation, which may include zero at the lower bound. Guideline values are conservatively presented as the concentrations in drinking-water associated with an estimated
upper-bound excess lifetime cancer risk of 105 (or one additional case of cancer per
100000 of the population ingesting drinking-water containing the substance at the
guideline value for 70 years). This value does not equate to the number of cases of
cancer that will be caused by exposure to the substance at this level. It is the maximum
potential risk, taking into account large uncertainties. It is highly probable that the
actual level of risk is less than this, even approaching zero, but risks at low levels of
exposure cannot be experimentally verified. The recognition that the cancer risk may
approach zero or be indistinguishable from zero stems from the uncertainties associated with mechanisms of carcinogenesis, including the role of the chemical in the
cancer process and the possibility of detoxification and repair mechanisms. Member
States may consider that a different level of hypothetical risk is more appropriate to
their circumstances, and values relating to risks of 104 or 106 additional cancer cases
over a lifetime of exposure may be determined by respectively multiplying or dividing
the guideline value by 10.
The mathematical models used for deriving guideline values for non-threshold
chemicals cannot be verified experimentally, and they do not usually take into account a number of biologically important considerations, such as pharmacokinetics,
pre-systemic and metabolic detoxification, DNA repair or protection by the immune
system. They also assume the validity of a linear extrapolation of very high dose exposures in test animals to very low dose exposures in humans. As a consequence, the models used are conservative (i.e. err on the side of caution). The guideline values derived
using these models should be interpreted differently from TDI-derived values because
of the lack of precision of the models. Moderate short-term exposure to levels exceeding
the guideline value for non-threshold chemicals does not significantly affect the risk.
8.2.4 Data quality
The following factors were taken into account in assessing the quality and reliability
of available information:
Oral studies are preferred (in particular, drinking-water studies), using the pure
substance with appropriate dosing regime and a good quality clinical biochemistry and histopathology.
165
The database should be sufficiently broad that all potential toxicological endpoints of concern have been identified.
The quality of the studies is such that they are considered reliable; for example,
there has been adequate consideration of confounding factors in epidemiological
studies.
There is reasonable consistency between studies; the end-point and study used to
derive a guideline value do not contradict the overall weight of evidence.
For inorganic substances, there is some consideration of speciation in drinkingwater.
There is appropriate consideration of multimedia exposure in the case of epidemiological studies.
Designation
166
8. Chemical aspects
167
8. Chemical aspects
169
1
2
3
4
5
6
7
8
1
2
3
4
5
Many kinds of field test kits are available to measure the concentrations of various
chemicals in water. These are generally used for compliance examinations as well as
for operational monitoring of drinking-water quality. Although the field test kits have
the advantage of being simple to use in non-laboratory environments and are often
available at relatively low prices, their analytical accuracy is generally less than that of
the methods shown in Tables 8.4 and 8.5. However, when properly used, they provide
valuable tools for rapidly assessing numerous contaminants in a non-formal laboratory setting at low cost compared with commercial laboratory tests. It is therefore
necessary to check the validity of the field test kit before applying it.
A brief description of the analytical methods listed in Tables 8.4 and 8.5 is provided in Annex 4.
8.4 Treatment
As noted above, where a health-based guideline value cannot be achieved by reasonably practicable treatment, then the guideline value is designated as provisional and
set at the concentration that can be reasonably achieved through treatment.
Collection, treatment, storage and distribution of drinking-water involve deliberate additions of numerous chemicals to improve the safety and quality of the finished
drinking-water for consumers (direct additives). In addition, water is in constant contact with pipes, valves, taps and tank surfaces, all of which have the potential to impart
additional chemicals to the water (indirect additives). The chemicals used in water
treatment or from materials in contact with drinking-water are discussed in more
detail in section 8.5.4.
170
8. Chemical aspects
Table 8.6 Ranking of technical complexity and cost of water treatment processes
Ranking
Simple chlorination
Plain filtration (rapid sand, slow sand)
Prechlorination plus filtration
Aeration
Chemical coagulation
Process optimization for control of DBPs
Granular activated carbon treatment
Ion exchange
Ozonation
Advanced oxidation processes
Membrane treatment
2
3
4
5
6
If a guideline value cannot be met with the existing system, then additional treatment may need to be considered, or water might need to be obtained from alternative
sources.
The cost of achieving a guideline value will depend on the complexity of any
additional treatment or other control measures required. It is not possible to provide general quantitative information on the cost of achieving individual guideline
values. Treatment costs (capital and operating) will depend not only on the factors
identified above, but also on issues such as plant throughput; local costs for labour,
civil and mechanical works, chemicals and electricity; life expectancy of the plant; and
so on. Guideline values may be progressively achieved in the long term through less
capital-intensive non-treatment options, such as through agreements with land users
to reduce application of chemicals (fertilizers, pesticides, etc.)
A qualitative ranking of treatment processes based on their degree of technical
complexity is given in Table 8.6. The higher the ranking, the more complex the process
in terms of plant or operation. In general, higher rankings are also associated with
higher costs.
Annex 5 summarizes the treatment processes that are capable of removing chemical contaminants of health significance. The tables in Annex 5 include only those
chemicals, by source category, for which some treatment data are available and for
which guideline values have been established.
171
The tables in Annex 5 are provided to help inform decisions regarding the ability
of existing treatment to meet guidelines and what additional treatment might need
to be installed. They have been compiled on the basis of published literature, which
includes mainly laboratory experiments, some pilot plant investigations and relatively
few full-scale studies of water treatment processes. Consequently:
Many of the treatments outlined are designed for larger treatment plants and
may not necessarily be appropriate for smaller treatment plants or individualtype treatment. In these cases, the choice of technology must be made on a caseby-case basis.
The information is probably best case, as the data would have been obtained
under laboratory conditions or with a carefully controlled plant for the purposes
of experimentation.
Actual process performance will depend on the concentration of the chemical in
the raw water and on general raw water quality. For example, chlorination and
removal of organic chemicals and pesticides using activated carbon or ozonation
will be impaired if there is a high concentration of natural organic matter.
For many contaminants, potentially several different processes could be appropriate, and the choice between processes should be made on the basis of technical complexity and cost, taking into account local circumstances. For example,
membrane processes can remove a broad spectrum of chemicals, but simpler and
cheaper alternatives are effective for the removal of most chemicals.
It is normal practice to use a series of unit processes (e.g. coagulation, sedimentation, filtration, chlorination) to achieve desired water quality objectives. Each of
these may contribute to the removal of chemicals. It may be technically and economically advantageous to use a combination of processes (e.g. ozonation plus
granular activated carbon or membranes) to remove particular chemicals.
The effectiveness of potential processes should be assessed using laboratory or
pilot plant tests on the actual raw water concerned. These tests should be of sufficient duration to identify potential seasonal or other temporal variations in contaminant concentrations and process performance.
These treatment technology characterizations are estimates and are not comprehensive, but are intended to provide some indications of the types of technologies
that have shown greater or lesser capabilities for removing the indicated chemicals from drinking-water.
172
8. Chemical aspects
173
Changing disinfectants
It may be feasible to change disinfectant in order to achieve guideline values for DBPs.
The extent to which this is possible will be dependent on the raw water quality and
installed treatment (e.g. for precursor removal).
It may be effective to change from chlorine to monochloramine to provide a
secondary disinfectant residual within distribution, in order to reduce THM formation and subsequent development within the distribution system. Although
monochloramine provides a more stable residual within distribution, it is a less
powerful disinfectant and should not be used as a primary disinfectant.
Chlorine dioxide can be considered as a potential alternative to both chlorine and
ozone disinfection, although it does not provide a residual effect, as chlorine would.
The main concerns with chlorine dioxide are with the residual concentrations of
chlorine dioxide and the by-products chlorite and chlorate. These can be addressed by
controlling the dose of chlorine dioxide at the treatment plant.
Non-chemical disinfection
Ultraviolet (UV) irradiation or membrane processes can be considered as alternatives
to chemical disinfection. UV is particularly effective at inactivating Cryptosporidium,
which is extremely resistant to chlorination. Neither of these provides any residual
disinfection, and it may be considered appropriate to add a small dose of a persistent
disinfectant such as chlorine or monochloramine to act as a preservative during distribution.
Removing DBPs prior to distribution
It is technically feasible to remove DBPs prior to distribution; however, this is the least
attractive option for controlling DBP concentrations. Strategies for DBP control include source control, precursor removal, use of alternative disinfectants and removal
of DBPs by technologies such as air stripping, activated carbon, UV light and advanced oxidation. These processes would need to be followed by a further disinfection
step to guard against microbial contamination and to ensure a residual concentration
of disinfectant within distribution.
8.4.3 Treatment for corrosion control
Corrosion is the partial dissolution of the materials constituting the treatment and
supply systems, tanks, pipes, valves and pumps. In certain circumstances, all water
can be corrosive. Corrosion may lead to structural failure, leaks, loss of capacity and
deterioration of chemical and microbial water quality. The internal corrosion of pipes
and fittings can have a direct impact on the concentration of water constituents, including lead and copper. Corrosion control is therefore an important aspect of the
management of a drinking-water system for safety.
Corrosion control involves many parameters, including the concentrations of
calcium, bicarbonate, carbonate and dissolved oxygen, as well as pH. The detailed
requirements differ depending on water quality and the materials used in the distribution system. The pH controls the solubility and rate of reaction of most of the metal
species involved in corrosion reactions. It is particularly important in relation to the
174
8. Chemical aspects
formation of a protective film at the metal surface. For some metals, alkalinity (carbonate and bicarbonate) and calcium (hardness) also affect corrosion rates.
Characterizing corrosivity
Most of the indices that have been developed to characterize the corrosion potential
of waters are based on the assumption that water with a tendency to deposit a calcium
carbonate scale on metal surfaces will be less corrosive. The Langelier index is the difference between the actual pH of a water and its saturation pH, this being the pH at
which a water of the same alkalinity and calcium hardness would be at equilibrium
with solid calcium carbonate. Waters with a positive Langelier index are capable of
depositing calcium carbonate scale from solution.
There is no corrosion index that applies to all materials, and corrosion indices,
particularly those related to calcium carbonate saturation, have given mixed results.
The parameters related to calcium carbonate saturation status are, strictly speaking,
indicators of the tendency to deposit or dissolve calcium carbonate (calcite) scale, not
indicators of the corrosivity of a water. For example, there are many waters with a
negative Langelier index that are non-corrosive and many with a positive Langelier
index that are corrosive. Nevertheless, there are many documented instances of the
use of saturation indices for corrosion control based on the concept of laying down
a protective eggshell scale of calcite in iron pipes. In general, waters with high pH,
calcium and alkalinity are less corrosive, and this tends to be correlated with a positive
Langelier index. However, these calcium carbonate precipitation indices are not necessarily considered to be good corrosion predictors for copper systems.
The ratio of the chloride and sulfate concentrations to the bicarbonate concentration (Larson ratio) has been shown to be helpful in assessing the corrosiveness of
water to cast iron and steel. A similar approach has been used in studying zinc dissolution from brass fittingsthe Turner diagram.
Water treatment for corrosion control
To control corrosion in water distribution networks, the methods most commonly
applied are adjusting pH, increasing the alkalinity or hardness or adding corrosion
inhibitors, such as polyphosphates, silicates and orthophosphates. The quality and
maximum dose to be used should be in line with specifications for such water treatment chemicals. Although pH adjustment is an important approach, its possible impact on other aspects of water supply technology, including disinfection, must always
be taken into account.
It is not always possible to achieve the desired values for all parameters. For example, the pH of hard waters cannot be increased too much, or softening will occur.
The application of lime and carbon dioxide to soft waters can be used to increase both
the calcium concentration and the alkalinity to at least 40mg/l as calcium carbonate.
More detailed information on the corrosion of various metals commonly used in
water treatment and distribution systems can be found in Annex 5.
8.4.4 Household treatment
The chemicals of greatest health concern in some natural waters are usually excess
natural fluoride, nitrate/nitrite and arsenic.
175
Some commercial water treatment technologies are available for small applications for the removal of chemical contaminants. For example, anion exchange using
activated alumina or iron-containing products will effectively reduce excess fluoride
concentrations. Bone char has also been used to reduce fluoride concentrations. Arsenic is also removed by anion exchange processes similar to those employed for fluoride. Nitrates and nitrates, which are frequently present due to sewage contamination
or agricultural runoff, are best managed by protecting the source water from contamination. They are difficult to remove, although disinfection will oxidize nitrite, the
more toxic form, to nitrate. In addition, disinfection will sanitize the water and reduce
the risk of gastrointestinal infection, which is a risk factor for methaemoglobinaemia
caused by excess nitrate/nitrite exposure of infants up to approximately 36 months
of age.
Cation exchange water softening is widely used in homes to remove excess hardness due to high calcium or magnesium, and it can also remove metals including iron
and radium.
Synthetic and natural organic chemicals can be removed by granular activated
carbon or carbon block technologies. The treatment systems must be well managed
and replaced regularly, because their effectiveness is eventually lost, depending upon
the types of contaminating chemicals and their concentrations in the water. Reverse
osmosis technologies have general applicability for removal of most organic and inorganic chemicals; however, there is some selectivity, and also there is a significant
amount of water wastage when low-pressure units are used in small-volume applications.
8. Chemical aspects
Table 8.7 Naturally occurring chemicals for which guideline values have not been established
Chemical
Remarks
Bromide
Table 8.8 Guideline values for naturally occurring chemicals that are of health significance in
drinking-water
Guideline value
Chemical
g/l
Inorganic
Arsenic
Barium
Boron
Chromium
Fluoride
10 (A, T)
700
2400
50 (P)
1500
Selenium
Uranium
Organic
Microcystin-LR
mg/l
0.01 (A, T)
0.7
2.4
0.05 (P)
1.5
Remarks
40 (P)
30 (P)
0.04 (P)
0.03 (P)
1 (P)
0.001 (P)
A, provisional guideline value because calculated guideline value is below the achievable quantification level; P,
provisional guideline value because of uncertainties in the health database; T, provisional guideline value because
calculated guideline value is below the level that can be achieved through practical treatment methods, source
protection, etc.
products containing the chemicals. In some cases, inappropriate handling and disposal may lead to contamination (e.g. degreasing agents that are allowed to reach
groundwater). Some of these chemicals, particularly inorganic substances, may also
be encountered as a consequence of natural contamination, but this may also be a byproduct of industrial activity, such as mining, that changes drainage patterns. Many
of these chemicals are used in small industrial units within human settlements, and,
particularly where such units are found in groups of similar enterprises, they may be a
significant source of pollution. Petroleum oils are widely used in human settlements,
and improper handling or disposal can lead to significant pollution of surface water
and groundwater. Where plastic pipes are used, the smaller aromatic molecules in
petroleum oils can sometimes penetrate the pipes where they are surrounded by earth
soaked in the oil, with subsequent pollution of the local water supply.
A number of chemicals can reach water as a consequence of disposal of general
household chemicals; in particular, a number of heavy metals may be found in domestic wastewater. Where wastewater is treated, these will usually partition out into
the sludge. Some chemicals that are widely used both in industry and in materials
used in a domestic setting are found widely in the environment (e.g. di(2-ethylhexyl)phthalate), and these may be found in water sources, although usually at low concentrations.
Some chemicals that reach drinking-water from industrial sources or human
settlements have other primary sources and are therefore discussed in other sections
of this chapter. Where latrines and septic tanks are poorly sited, these can lead to contamination of drinking-water sources with nitrate (see section 8.5.3).
Identification of the potential for contamination by chemicals from industrial activities and human dwellings requires assessment of activities in the catchment and of
178
8. Chemical aspects
Table 8.9 Chemicals from industrial sources and human dwellings for which guideline values
have not been established
Chemical
Beryllium
Cyanide
1,3-Dichlorobenzene
1,1-Dichloroethane
1,1-Dichloroethene
Di(2-ethylhexyl)adipate
Hexachlorobenzene
Methyl tertiary-butyl ether
Monochlorobenzene
Nitrobenzene
Petroleum products
Trichlorobenzenes (total)
1,1,1-Trichloroethane
the risk that particular contaminants may reach water sources. The primary approach
to addressing these contaminants is prevention of contamination by encouraging
good practices. However, if contamination has occurred, then it may be necessary to
consider the introduction of treatment.
Guideline values have not been established for the chemicals listed in Table8.9 for
the reasons indicated in the table. Fact sheets for each are included in chapter 12.
Guideline values have been established for the chemicals listed in Table 8.10,
which meet all of the criteria for inclusion. Fact sheets for each are included in
chapter 12.
8.5.3 Chemicals from agricultural activities
Chemicals are used in agriculture on crops and in animal husbandry. Nitrate may
be present as a consequence of tillage when there is no growth to take up nitrate released from decomposing plants, from the application of excess inorganic or organic
fertilizer and in slurry from animal production. Most chemicals that may arise from
179
Table 8.10 Guideline values for chemicals from industrial sources and human dwellings that
are of health significance in drinking-water
Guideline value
Chemicals
g/l
mg/l
Inorganic
Cadmium
Mercury
3
6
0.003
0.006
10a
0.01a
Carbon tetrachloride
0.004
1,2-Dichlorobenzene
1000 (C)
1 (C)
1,4-Dichlorobenzene
300 (C)
0.3 (C)
1,2-Dichloroethane
30a
0.03a
1,2-Dichloroethene
50
0.05
Dichloromethane
20
Remarks
Organic
Benzene
Di(2-ethylhexyl)phthalate
1,4-Dioxane
0.02
0.008
50a
0.05a
Edetic acid
600
0.6
Ethylbenzene
300 (C)
0.3 (C)
0.6
0.0006
Hexachlorobutadiene
Nitrilotriacetic acid
Pentachlorophenol
200
0.2
9 (P)
a
0.009a (P)
Styrene
20 (C)
0.02 (C)
Tetrachloroethene
40
0.04
Toluene
Trichloroethene
Xylenes
700 (C)
0.7 (C)
20 (P)
0.02 (P)
500 (C)
0.5 (C)
C, concentrations of the substance at or below the health-based guideline value may affect the appearance, taste or
odour of the water, leading to consumer complaints; P, provisional guideline value because of uncertainties in the
health database
a
For non-threshold substances, the guideline value is the concentration in drinking-water associated with an upperbound excess lifetime cancer risk of 105 (one additional case of cancer per 100 000 of the population ingesting
drinking-water containing the substance at the guideline value for 70 years). Concentrations associated with
estimated upper-bound excess lifetime cancer risks of 104 and 106 can be calculated by multiplying and dividing,
respectively, the guideline value by 10.
agriculture are pesticides, although their presence will depend on many factors, and
not all pesticides are used in all circumstances or climates. Contamination can result
from application and subsequent movement following rainfall or from inappropriate
disposal methods.
Some pesticides are also used in non-agricultural circumstances, such as the control of weeds on roads and railway lines. These pesticides are also included in this
section.
180
8. Chemical aspects
Table 8.11 Chemicals from agricultural activities excluded from guideline value derivation
Chemical
Amitraz
Chlorobenzilate
Chlorothalonil
Cypermethrin
Deltamethrin
Diazinon
Dinoseb
Ethylene thiourea
Fenamiphos
Formothion
Hexachlorocyclohexanes
(mixed isomers)
MCPBa
Methamidophos
Methomyl
Mirex
Monocrotophos
Oxamyl
Phorate
Propoxur
Pyridate
Pyriproxyfen
Quintozene
Toxaphene
Triazophos
Tributyltin oxide
Trichlorfon
a
b
4-(4-chloro-o-tolyloxy)butyric acid.
The use of pyriproxyfen as a larvicide for public health purposes is discussed further in section 8.6.
Guideline values have not been established for the chemicals listed in Table 8.11,
as a review of the literature on occurrence or credibility of occurrence in drinkingwater has shown evidence that the chemicals do not occur in drinking-water.
Guideline values have not been established for the chemicals listed in Table 8.12
for the reasons indicated in the table. Fact sheets for each are included in chapter 12.
181
Table 8.12 Chemicals from agricultural activities for which guideline values have not been
established
Chemical
Ammonia
Bentazone
Carbaryl
1,3-Dichloropropane
Diquat
Endosulfan
Fenitrothion
Heptachlor and heptachlor Occur in drinking-water at concentrations well below those of health
epoxide
concern
Malathion
Methyl parathion
Parathion
Propanil
Aminomethylphosphonic acid.
Guideline values have been established for the chemicals listed in Table 8.13,
which meet the criteria for inclusion. Fact sheets for each are included in chapter 12.
8.5.4 Chemicals used in water treatment or from materials in contact with
drinking-water
Chemicals used in water treatment and chemicals arising from materials in contact
with water may give rise to contaminants in the final water.
Some substances are deliberately added to water in the course of treatment (direct additives), some of which may be inadvertently retained in the finished water
182
8. Chemical aspects
Table 8.13 Guideline values for chemicals from agricultural activities that are of health
significance in drinking-water
Guideline value
Chemical
g/l
mg/l
Remarks
Non-pesticides
Nitrate (as NO3)
50 000
50
3 000
Short-term exposure
Short-term exposure; a provisional
guideline value for chronic effects
of nitrite that was in the third
edition has been suspended and is
under review owing to significant
uncertainty surrounding the
endogenous formation of nitrite and
concentrations in human saliva.
20a
0.02a
Aldicarb
10
0.01
0.00003
0.03
100
7
0.2
0.1
0.007
0.000 2
Chlorotoluron
30
0.03
Chlorpyrifos
30
0.03
Cyanazine
2,4-D
2,4-DBc
0.6
0.000 6
30
0.03
90
0.09
1,2-Dibromo-3-chloropropane
1a
0.001a
1,2-Dibromoethane
0.4a (P)
0.000 4a (P)
1,2-Dichloropropane
40 (P)
0.04 (P)
1,3-Dichloropropene
20a
0.02a
Dichlorprop
100
Dimethoate
Endrin
0.6
0.000 6
Fenoprop
0.009
Hydroxyatrazine
200
0.1
0.006
0.2
Isoproturon
0.009
Lindane
0.002
MCPAd
0.002
Mecoprop
10
0.01
Methoxychlor
20
0.02
Metolachlor
10
0.01
183
Atrazine metabolite
g/l
mg/l
0.006
20
0.02
0.002
9
7
20
0.009
0.007
0.02
Remarks
(e.g. salts, coagulant polymer residues or monomers). Chloramine and chlorine disinfectant residuals, for example, are deliberate additives, and their presence confers
a benefit. Others, such as DBPs, are generated during chemical interactions between
disinfectant chemicals and substances normally in water (Table 8.14). Chlorination
by-products and other DBPs may also occur in swimming pools, from which exposure
by inhalation and skin absorption will be of greater importance (WHO, 2006).
Other chemicals, such as lead or copper from pipes or brass taps and chemicals
leaching from coatings, may be taken up from contact with surfaces during treatment
or distribution (indirect or unintentional additives).
Some chemicals used in water treatment (e.g. aluminium) or in materials in contact with drinking-water (e.g. styrene) have other principal sources and are therefore
discussed in detail in other sections of this chapter.
Many of these additives, both direct and indirect or unintentional, are components of processes for producing safe drinking-water. The approach to monitoring and
management is preferably through control of the material or chemical. It is important to optimize treatment processes and to ensure that such processes remain optimized in order to control residuals of chemicals used in treatment and to control the
formation of DBPs. Inadvertent contamination caused by poor quality materials is
best controlled by applying specifications governing the composition of the products
themselves rather than by setting limits on the quality of finished water, whereas contamination due to the inappropriate use of additives can be addressed by guidance on
use. Similarly, regulations on the quality of pipe can avoid possible contamination of
water by leachable materials. Control of contamination from in situ applied coatings
requires suitable codes of practice on their application in addition to controls on the
composition of materials.
Numerous national and third-party evaluation and approval systems for additives
and materials for contact with drinking-water exist throughout the world; however,
184
8. Chemical aspects
Table 8.14 Disinfection by-products present in disinfected waters (based on IPCS, 2000)
Disinfectant
Chlorine/
hypochlorous acid
(hypochlorite)
Significant
Significant
organohalogen products inorganic products
Aldehydes, cyanoalkanoic
acids, alkanoic acids,
benzene, carboxylic acids,
N-nitrosodimethylamine
Chlorine dioxide
Chlorite, chlorate
Unknown
Chloramine
Haloacetonitriles,
Nitrate, nitrite,
cyanogen chloride, organic chlorate, hydrazine
chloramines, chloramino
acids, chloral hydrate,
haloketones
Aldehydes, ketones,
N-nitrosodimethylamine
Ozone
Bromoform,
monobromoacetic
acid, dibromoacetic
acid, dibromoacetone,
cyanogen bromide
Aldehydes, ketoacids,
ketones, carboxylic acids
Chlorate, iodate,
bromate, hydrogen
peroxide, hypobromous acid,
epoxides, ozonates
Sodium
As for chlorine/
dichloroisocyanurate hypochlorous acid
(hypochlorite)
Cyanuric acid
many countries do not have or operate such systems. Governments and other organizations should consider establishing or adapting additive management systems and setting product quality standards and guidance on use that would apply to determining
acceptable water contact products. Ideally, harmonized standards between countries
or reciprocal recognition would reduce costs and increase access to such standards
(see also section 1.2.9).
Guideline values have not been established for the chemicals listed in Table 8.15
for the reasons indicated in the table. Fact sheets for each are included in chapter 12.
Guideline values have been established for the chemicals listed in Table 8.16,
which meet the criteria for inclusion. Fact sheets for each are included in chapter 12.
Indicator substances for monitoring chlorination by-products
Although guideline values have been established for a number of chlorination
by-products, data from drinking-water supplies indicate that THMs and HAAs are
adequate as indicators of the majority of chlorination by-products. The most appropriate means of controlling chlorination by-products is to remove the organic precursors, which are largely of natural origin. Measurement of THMs and, if appropriate,
HAAs (e.g. where water is chlorinated at a low pH) can be used to optimize treatment
efficiency and to establish the boundaries of other operational parameters that can be
used to monitor treatment performance. In these circumstances, monitoring frequencies of other chlorination by-products can be reduced. Although total organohalogen
does not correlate well with either THMs or HAAs, it is a measure of total chlorination
by-products and may be another potential indicator for operational purposes.
185
Table 8.15 Chemicals used in water treatment or materials in contact with drinking-water for
which guideline values have not been established
Chemical
Disinfectants
Chlorine dioxide
Dichloramine
Iodine
Silver
Trichloramine
Disinfection by-products
Bromochloroacetate
186
8. Chemical aspects
3-Chloro-4-dichloromethyl-5-hydroxy-2(5H)-furanone.
See fact sheet on polynuclear aromatic hydrocarbons.
May affect acceptability of drinking-water (see chapter 10).
Table 8.16 Guideline values for chemicals used in water treatment or materials in contact with
drinking-water that are of health significance in drinking-water
Guideline valuea
Chemical
g/l
mg/l
Remarks
5 (C)
Disinfectants
Chlorine
Monochloramine
Sodium
dichloroisocyanurate
5 000 (C)
3 000
50 000
50
As sodium dichloroisocyanurate
40 000
40
As cyanuric acid
Disinfection by-products
Bromate
10a (A, T)
0.01a (A, T)
Bromodichloromethane
60a
0.06a
Bromoform
100
Chlorate
700 (D)
0.7 (D)
Chlorite
700 (D)
0.7 (D)
Chloroform
300
0.3
70
0.07
100
0.1
Dibromoacetonitrile
Dibromochloromethane
0.1
Dichloroacetate
50a (D)
0.05a (D)
Dichloroacetonitrile
20 (P)
0.02 (P)
187
g/l
mg/l
20
0.02
0.1
Remarks
0.0001
Trichloroacetate
200
0.2
2,4,6-Trichlorophenol
200 (C)
0.2a (C)
Trihalomethanes
0.5a
0.0005a
Epichlorohydrin
0.4 (P)
0.0004 (P)
20
0.02
0.7
2000
0.0007a
2
Lead
10 (A, T)
0.01 (A, T)
Nickel
70
0.07
Vinyl chloride
0.3a
0.0003a
A, provisional guideline value because calculated guideline value is below the achievable quantification level; C,
concentrations of the substance at or below the health-based guideline value may affect the appearance, taste or
odour of the water, leading to consumer complaints; D, provisional guideline value because disinfection is likely to
result in the guideline value being exceeded; P, provisional guideline value because of uncertainties in the health
database; T, provisional guideline value because calculated guideline value is below the level that can be achieved
through practical treatment methods, source control, etc.
a
For substances that are considered to be carcinogenic, the guideline value is the concentration in drinking-water
associated with an upper-bound excess lifetime cancer risk of 105 (one additional case of cancer per 100 000 of the
population ingesting drinking-water containing the substance at the guideline value for 70 years). Concentrations
associated with estimated upper-bound excess lifetime cancer risks of 104 and 106 can be calculated by multiplying
and dividing, respectively, the guideline value by 10.
In all circumstances, disinfection efficiency should not be compromised in trying to meet guidelines for DBPs, including chlorination by-products, or in trying to
reduce concentrations of these substances.
Contaminants from storage and generation of hypochlorite solutions
Sodium hypochlorite solutions slowly decomposemore rapidly at warmer temperaturesto produce chlorate and chlorite ions. As the solution ages and the available
chlorine concentration decreases, it is necessary to dose more product to achieve the
desired residual chlorine concentration, with a consequent increase in the amounts
of chlorate and chlorite added to the treated water. The decomposition of solid calcium hypochlorite is much slower, and consequently contamination is less likely to be
significant. However, if calcium hypochlorite solutions are prepared and stored before
use, then decomposition to form chlorate and chlorite would also occur.
188
8. Chemical aspects
8. Chemical aspects
Table 8.17 Pesticides used for public health purposes for which guideline values have not been
derived
Pesticide
Bacillus thuringiensis
israelensis (Bti)
Not considered appropriate to set guideline values for pesticides used for
vector control in drinking-water
Diflubenzuron
Not considered appropriate to set guideline values for pesticides used for
vector control in drinking-water
Methoprene
Not considered appropriate to set guideline values for pesticides used for
vector control in drinking-water
Not considered appropriate to set guideline values for pesticides used for
vector control in drinking-water
Not recommended for direct addition to drinking-water as part of WHOs
policy to exclude the use of any pyrethroids for larviciding of mosquito
vectors of human disease
Not recommended for use for vector control in drinking-water
Novaluron
Permethrin
Pirimiphos-methyl
Pyriproxyfen
Spinosad
Temephos
Not considered appropriate to set guideline values for pesticides used for
vector control in drinking-water
Not considered appropriate to set guideline values for pesticides used for
vector control in drinking-water
Not considered appropriate to set guideline values for pesticides used for
vector control in drinking-water
any larvicide no greater than that recommended by WHOPES and as low as possible
commensurate with efficacy.
Member States should consider the use of larvicides within the context of their
broad vector control strategy. The use of larvicides should be only part of a comprehensive management plan for household water storage and domestic waste management that does not rely exclusively on larviciding by insecticides, but also includes
other environmental management measures and social behaviour change. Nevertheless, it would be valuable to obtain actual data on exposure to these substances
under field conditions in order to carry out a more refined assessment of margins of
exposure.
In addition to the use of larvicides approved for drinking-water application to
control disease vector insects, other control measures should also be considered. For
example, the stocking of fish of appropriate varieties (e.g. larvae-eating mosquitofish and predatory copepods) in water bodies may adequately control infestations and
breeding of mosquitoes in those bodies. Other mosquito breeding areas where water
collects should be managed by draining, especially after rainfall.
Those pesticides used for public health purposes for which guideline values have
not been derived are listed in Table 8.17. Dichlorodiphenyltrichloroethane (DDT) has
been used for public health purposes in the past. It is being reintroduced (but not for
water applications) in some areas to control malaria-carrying mosquitoes. Its guideline value is shown in Table 8.18. A summary of the product formulations and dosage
rates, with corresponding exposures, is provided in Table 8.19.
Fact sheets for all larvicides considered in the Guidelines are included in chapter 12.
191
Table 8.18 Guideline values for pesticides that were previously used for public health purposes
and are of health significance in drinking-water
Guideline value
g/l
mg/l
0.001
8. Chemical aspects
Table 8.19 WHO-recommended compounds and formulations for control of mosquito larvae in
container habitatsa
Insecticide
Formulation
Bacillus thuringiensis
israelensis (Bti)d
WG
Diflubenzuron
DT, GR, WP
Methoprene
Dosage
(mg/l)b
ADI
Exposure
(mg/kg bw) (mg/kg bw)c
15
0.020.25
EC
Novaluron
Use in drinkingwater
Adult: 0.17
Child: 0.5
Infant: 0.75
Can be used at
recommended
doses
00.02
Adult: 0.008
Child: 0.025e
Infant: 0.0375e
Can be used at
recommended
doses
00.09
Adult: 0.033
Child: 0.1e
Infant: 0.15e
Can be used at
recommended
doses
EC
0.010.05
00.01
Adult: 0.0017
Child: 0.005
Infant: 0.0075
Can be used at
recommended
doses
Pirimiphos-methyl
EC
00.03
Adult: 0.033
Child: 0.1e
Infant: 0.15e
Not
recommended
for direct
application to
drinking-water
Pyriproxyfen
GR
0.01
00.1
Adult: 0.000 33
Child: 0.001
Infant: 0.0015
Can be used at
recommended
doses
Spinosad
DT, GR, SC
0.10.5f
00.02
Adult: 0.0017
Child: 0.0052
Infant: 0.0078
Can be used at
recommended
doses
Temephos
EC, GR
0.023g
Adult: 0.033
Child: 0.1e
Infant: 0.15e
Can be used at
recommended
doses
bw, body weight; DT, tablet for direct application; EC, emulsifiable concentrate; GR, granule; SC, suspension concentration; WG, water dispersible granule; WP, wettable powder
a
WHO recommendations on the use of pesticides in public health are valid only if linked to WHO specifications for
their quality control. WHO specifications for public health pesticides are available at http://who.int/whopes/quality/en.
Label instructions must always be followed when using insecticides.
b
Active ingredient for control of container-breeding mosquitoes.
c
Exposure at the maximum dosage in drinking-water for (a) a 60 kg adult drinking 2 litres of water per day, (b) a 10 kg
child drinking 1 litre of water per day and (c) a 5 kg bottle-fed infant drinking 0.75 litre of water per day.
d
Bti itself is not considered to pose a hazard to humans through drinking-water.
e
Consideration should be given to using alternative sources of water for small children and bottle-fed infants for a
period after application, where this is practical. However, exceeding the ADI will not necessarily result in adverse
effects.
f
The maximum concentration actually achieved with the slow-release formulation of spinosad was approximately
52g/l.
g
This is a TDI rather than an ADI, as JMPR considered that the database was insufficiently robust to serve as the basis
for establishing an ADI for temephos. For the purposes of these Guidelines, a TDI has been calculated from the lowest
oral NOAEL in the critical study identified by JMPR.
Source: Adapted from WHO/TDR (2009)
193
This section of the Guidelines can be used to assist evaluation of the risks
a ssociated with a particular situation andespecially if a guideline value exists or
an authoritative risk assessment is available from an alternative sourcesupport
appropriate decision-making on short- and medium-term actions. The approaches
proposed provide a basis for discussion between various authorities and for judging
the urgency of taking further action.
Normally, a specific review of the situation will be required and should call on
suitable expertise. It is important to take local circumstances into account, including
the availability of alternative water supplies and exposure to the contaminant from
other sources, such as food. It is also important to consider what water treatment is
applied or available and whether this will reduce the concentration of the substance.
Where the nature of contamination is unknown, expert opinion should be sought
as quickly as possible to identify the contaminants, to determine what actions can be
taken to prevent the contaminants from entering the supply and to minimize the exposure of the population and so minimize any potential for adverse effects.
A water safety plan should include planning for response to both predictable
events and undefined emergencies. Such planning facilitates rapid and appropriate
response to events when they occur (see section 4.4).
Consideration of emergency planning and planning for response to incidents in
which a guideline value is exceeded, covering both microbial and chemical contaminants, is discussed in section 4.4. Broader discussion of actions in emergency situations
can be found in section 6.7 and, for microbial contamination, section 7.6.
8.7.1 Trigger for action
Triggers for action may include:
194
8. Chemical aspects
In addition, timely and clear communication with consumers is a vital part of successfully handling drinking-water problems and emergencies.
Liaison with key authorities is discussed in section 4.4. It is particularly important to inform the public health authority of any exceedance or likely exceedance of a
guideline value or other conditions likely to affect human health and to ensure that
the public health authority is involved in decision-making. In the event of actions that
require all consumers to be informed or where the provision of temporary supplies of
drinking-water is appropriate, civil authorities should also be involved. Planning for
these actions is an important part of the development of water safety plans. Involving
the public health authorities at an early stage enables them to obtain specialist information and to make the appropriate staff available.
8.7.4 Informing the public
Consumers may be aware of a potential problem with the safety of their drinkingwater because of media coverage, their own senses or informal networks. Lack of confidence in the drinking-water or the authorities may drive consumers to alternative,
potentially less safe sources. Not only do consumers have a right to information on
the safety of their drinking-water, but they have an important role to play in assisting
the authorities in an incident by their own actions and by carrying out the necessary
measures at the household level. Trust and goodwill from consumers are extremely
important in both the short and long term.
The health authorities should be involved whenever a decision to inform the public of health-based concerns or advice to adopt health protection measures such as
boiling of water may be required. Such guidance needs to be both timely and clear.
8.7.5 Evaluating the significance to public health and individuals
In assessing the significance of an exceedance of a guideline value, account should be
taken of:
sources of the chemicals concerned, including their allocation factors. When rapid
decision-making is required for such chemicals, it is possible to allow 100% of the
TDI to come from drinking-water for a short period (e.g. a few days) while undertaking a more substantive review. In the event that there is significant exposure from
other sources or exposure is likely to be for more than a few days, then it is possible to
allocate more than the allocation used in the guideline value derivation, but no more
than 100%.
In some cases, the guideline value is derived from epidemiological or clinical
studies in humans. In most cases (e.g. benzene, barium), these relate to long-term
exposure, and short-term exposure to concentrations higher than the guideline value
is unlikely to be of significant concern; however, it is important to seek expert advice.
In other cases of guideline values derived from epidemiological studies, the associated
health effects are acute in nature. For example:
The guideline value for nitrate (50 mg/l) is based on the occurrence of methaemoglobinaemia, or blue-baby syndrome, in bottle-fed infants. This outcome
is complicated by the concurrent presence of microbial contamination, which
can significantly increase the risk to this group. Methaemoglobinaemia has
rarely been associated with nitrate in the absence of faecal contamination of the
drinking-water. As a short-term measure, water should not be used for bottlefed infants when nitrate levels are above 100 mg/l; however, it may be used if
medical authorities are increasingly vigilant when the nitrate concentration is
between 50 and 100 mg/l, provided that the water is known and is confirmed to
be microbially safe. The guideline value for nitrate relates to a specific and vulnerable subgroup (i.e. bottle-fed infants), and therefore the guideline value will be
more than adequately protective for older children and adults.
The guideline value for copper is also based on short-term exposure but is intended to protect against direct gastric irritation, which is a concentration-dependent
phenomenon. The guideline value may be exceeded, but there will be an increasing risk of consumers suffering from gastrointestinal irritation as the concentration increases above the guideline value. The occurrence of such irritation can be
assessed in exposed populations.
In some cases, the guideline value is derived from a cancer risk estimate obtained
from studies in laboratory animals. In these cases, short-term (a few months to a year)
exposure to concentrations up to 10 times the guideline value would result in only
a small increase in estimated risk of cancer. Because the estimate of risk varies over
a wide range, there may be no, or a very small, increase in risk. In such a circumstance, accepting a 10-fold increase in the guideline value for a short period would
have no discernible impact on the risk over a lifetime. However, care would be needed
to determine whether other toxicological end-points more relevant for short-term
exposure, such as neurotoxicity, would become significant.
Health-based values for short-term exposures are now being developed for a small
number of substances that are used in significant quantities and are frequently implicated in an emergency as a consequence of spills, usually to surface water sources. The
methodology used in the derivation of these health-based values is described below.
196
8. Chemical aspects
Health-based values for acute and short-term exposures provide a basis for deciding when water can continue to be supplied without serious risk to consumers in
such an emergency situation. However, it is important to minimize exposure wherever
practical. It is recognized that losing a water supply carries risks to public health and is
a major challenge to maintaining proper hygiene as well as ensuring the availability of
microbially safe drinking-water. The acute and short-term health-based values assist
in determining the balance of risks between supplying water containing a contaminant and not supplying water in such emergencies.
Assessing locally relevant sources of the substance of concern through other
routes of exposure
The most useful sources of information regarding local exposure to substances
through food and, to a lesser extent, air and other environmental routes are usually
government departments dealing with food and environmental pollution. Other
sources of information may include universities. In the absence of specific data,
the Guidelines background documents consider the sources of exposure and give
a generic assessment that can be used to make a local evaluation as to the potential
use of a chemical and whether this would be likely to enter the food-chain. Further
information is available in the supporting document Chemical safety of drinkingwater (Annex 1).
Sensitive subpopulations
In some cases, there may be a specific subpopulation that is at greater risk from a substance than the rest of the population. These usually relate to high exposure relative to
body weight (e.g. bottle-fed infants) or a particular sensitivity (e.g. fetal haemoglobin
and nitrate/nitrite). However, some genetic subpopulations may show greater sensitivity to particular toxicity (e.g. glucose-6-phosphate dehydrogenasedeficient groups
and oxidative stress on red blood cells). If the potential exposure from drinking-water
in an incident is greater than the ADI or TDI or exposure is likely to be extended
beyond a few days, then this would require consideration in conjunction with health
authorities. In such circumstances, it may be possible to target action to avoid exposure of the specific group concerned, such as supplying bottled water for bottle-fed
infants.
Specific mitigation measures affecting risk assessment
Such measures relate to actions taken locally or on a household basis that can have an
impact on the presence of a particular contaminant. For example, the presence of a
substance that is volatile or heat labile will be affected by heating the water for cooking
or the preparation of beverages. Where such measures are routinely undertaken by the
exposed population, the risk assessment may be modified accordingly. Alternatively,
such steps can be used on a household basis to reduce exposure and allow the continued use of the supply without interruption.
8.7.6 Determining appropriate action
Determining appropriate action means that various risks will need to be balanced.
The interruption of water supply to consumers is a serious step and can lead to
198
8. Chemical aspects
appropriate action must take local circumstances into consideration. Specialist advice
should generally be sought.
8.7.10 Water avoidance advisories
Water avoidance advisories share many features with boil water advisories (see section 7.6.1), but are less common. Like boil water advisories, they are a serious measure
that should be instituted only when there is evidence that an advisory is necessary to
reduce a substantial public health risk. In cases where alternative sources of water are
recommended, particular consideration should be given to the potential for microbial hazards in those alternative sources. Water avoidance advisories are applied when
the parameter of concern is not susceptible to boiling or when risks from dermal
contact or inhalation of the contaminant are also significant. Water avoidance advisories may also be issued when an unknown agent or chemical substance is detected
in the distribution system. It is important that the water avoidance advisories include
the information that boiling is ineffective or insufficient to reduce the risk.
As with the case of boil water advisories, water suppliers in conjunction with
public health authorities should develop protocols for water avoidance advisories.
Protocols should be prepared before any incident occurs and incorporated within
water safety plans. Decisions to issue advisories are often made within a short period
of time, and developing responses during an event can complicate decision-making,
compromise communication and undermine public confidence.
In addition to the information discussed in section 4.4.3, the protocols should
provide information to the general public and specific groups on the following:
The methods chosen should provide a reasonable assurance that all of those affected
by the advisory, including residents, workers and travellers, are notified as soon as
possible.
The issuing of a water avoidance advisory may be necessary, for example, following contaminationfor example, chemical or radiologicalas a result of accidental,
natural or malicious origin that leads to:
8. Chemical aspects
When issued, water avoidance advisories should provide information on the same
issues included in boil water advisories (see section 7.6.1), although recommendations
relating to affected uses and users will vary, depending on the nature of the problem.
For example, for elevated concentrations of contaminants that are of concern only
from a drinking or cooking perspective, the public could be advised to avoid using
the water for drinking, food preparation, preparing cold drinks, making ice and hygienic uses, such as tooth brushing. Where the advisory applies to elevated levels of
chemicals that can cause skin or eye irritation or gastrointestinal upsets, the public
could be advised not to use the water for drinking, cooking, tooth brushing or bathing/showering. Alternatively, specific water avoidance advice might be issued where
the contamination might affect subgroups of the populationfor example, pregnant
women or bottle-fed infants.
As for boil water advisories, specific advice may need to be issued for dentists,
doctors, hospitals and other health-care facilities, child-care facilities, schools, food
suppliers and manufacturers, hotels, restaurants and operators of public swimming
pools.
Water avoidance advisories do not equate to cessation of supply; water will generally be suitable for flushing toilets and other uses, such as clothes washing. However,
suitable alternative supplies of drinking-water, such as bottled water and carted or
tankered water, will be required for drinking and other domestic uses.
Criteria for rescinding water avoidance advisories will generally be based on evidence that the source of elevated concentrations of hazardous contaminants has been
removed, that distribution systems have been appropriately flushed and that the water
is safe for drinking and other uses. In buildings, the flushing would extend to storages
and internal plumbing systems.
201
9
Radiological aspects
Introduction
(Chapter 1)
rinking-water may
FRAMEWORK FOR SAFE DRINKING-WATER
SUPPORTING
contain radioactive
INFORMATION
substances
(radionuPublic health context
Health-based targets
Microbial aspects
and health outcome
(Chapter 3)
(Chapters 7 and 11)
clides) that could present
Chemical aspects
a risk to human health.
Water safety plans
(Chapters 8 and 12)
(Chapter 4)
These risks are normally
Radiological
System
Management and
Monitoring
small compared with
aspects
assessment
communication
(Chapter 9)
the risks from microorAcceptability
ganisms and chemicals
Surveillance
aspects
(Chapter 5)
that may be present in
(Chapter 10)
drinking-water. Except in
extreme circumstances,
Application of the Guidelines
in specific circumstances
the radiation dose re(Chapter 6)
sulting from the ingesClimate change, Emergencies,
tion of radionuclides in
Rainwater harvesting, Desalination
systems, Travellers, Planes and
drinking-water is much
ships, etc.
lower than that received
from other sources of radiation. The objective of this chapter is to provide criteria with
which to assess the safety of drinking-water with respect to its radionuclide content and
to provide guidance on reducing health risks by taking measures to decrease radionuclide concentrations, and therefore radiation doses, in situations where this is considered
necessary.
In terms of health risk assessment, the Guidelines do not differentiate between
radionuclides that occur naturally and those that arise from human activities. However, in terms of risk management, a differentiation is made because, in principle,
human-made radionuclides are often controllable at the point at which they enter
the water supply. Naturally occurring radionuclides, in contrast, can potentially enter
the water supply at any point, or at several points, prior to consumption. For this
reason, naturally occurring radionuclides in drinking-water are often less amenable
to control.
203
When the term source appears in this chapter without any other reference, it is used in the context of
radiation source. For any other purpose, additional information is provided (e.g. water source).
204
9. RADIOLOGICAL ASPECTS
(around 0.01 mSv) is due to other sources of human-made radiation (see Figure 9.1).
There can be large variability in the dose received by individual members of the population, depending on where they live, their dietary preferences and other lifestyle choices.
Individual radiation doses can also differ depending on medical treatments and occupational exposures. Annual average doses and typical ranges of individual doses from
naturally occurring sources are presented in Table 9.1 (UNSCEAR, 2008).
9.1.1 Radiation exposure through ingestion of drinking-water
Water sources can contain radionuclides of natural and artificial origin (i.e. humanmade):
Natural radionuclides, including potassium-40, and those of the thorium and uranium decay series, in particular radium-226, radium-228, uranium-234, uranium238 and lead-210, can be found in water as a result of either natural processes (e.g.
absorption from the soil) or technological processes involving naturally occurring
radioactive materials (e.g. the mining and processing of mineral sands or phosphate
fertilizer production).
Human-made radionuclides may be present in water from several sources, such as
radionuclides discharged from nuclear fuel cycle facilities;
manufactured radionuclides (produced and used in unsealed form in medicine
or industry) entered into drinking-water supplies as a result of regular or
incidental discharges;
radionuclides released in the past into the environment, including drinkingwater sources.
205
Figure 9.1 Distribution of average radiation exposure for the world population
External exposure
Cosmic rays
0.39
0.31a
0.48
0.31b
1.26
0.210c
0.29
0.21d
Total
2.4
113
Internal exposure
b
c
206
9. RADIOLOGICAL ASPECTS
A planned exposure situation is a situation that arises from the planned operation of
a radiation source or from a planned activity that results in an exposure to a radiation
source (e.g. exposure to a radiation source during a medical procedure for diagnosis or
treatment).
An existing exposure situation is a situation that already exists when a decision on the
need for control has to be taken (e.g. exposure to indoor radon in dwellings).
An emergency exposure situation is a situation that arises as a result of an accident,
a malicious act or any other unexpected event. The present Guidelines do not apply
during emergency exposure situations (see chapter 6).
Individual doses from natural radioactivity in the environment vary widely. The average
is about 2.4 mSv/year, but in some parts of the world, average doses can be up to
10 times higher (i.e. 24 mSv/year) without any observed increase in health risks, as
noted in long-term population studies (Tao, 2000; Nair et al., 2009). An IDC of 0.1 mSv/
year therefore represents a small addition to natural levels.
The nominal risk coefficient for radiation-induced cancer incidence is 5.5 102/Sv
(ICRP, 2008). Multiplying this by an IDC of 0.1 mSv/year from drinking-water gives an
estimated annual cancer risk of approximately 5.5 106.
Figure 9.2 Application of screening and guidance levels for radionuclides in drinking-water
In the second edition of the Guidelines, the IDC of 0.1 mSv/year was based on
screening levels for gross alpha activity and gross beta activity of 0.1 Bq/l and 1 Bq/l,
respectively. This IDC represents less than 5% of the average annual dose attributable to radiation of natural origin (see section 9.1). Subsequent experience indicated
that, in practice, the 0.1 mSv annual dose would usually not be exceeded if the gross
alpha activity was equal to or below 0.5 Bq/l. For this reason, in the third edition of
the Guidelines, the IDC was based on screening levels of 0.5 Bq/l for gross alpha activity and 1 Bq/l for gross beta activity. This change was carried forward to the current
edition of the Guidelines.
9. RADIOLOGICAL ASPECTS
3.
4.
In the European Commission Drinking Water Directive (European Commission, 2001), this parameter is
called the total indicative dose (TID), and the same value of 0.1 mSv/year is adopted.
2
References for analytical methods and treatment technologies specific to radionuclides are provided in
Annex 6.
209
beta activity of potassium-40 is 27.9 Bq/g of stable potassium, which is the factor that
should be used to calculate the beta activity due to potassium-40.
9.3.2 Strategy for assessing drinking-water if screening levels are exceeded
If either of the screening levels is exceeded, then the specific radionuclides should
be identified and their individual activity concentrations measured. This will allow
the contribution from each radionuclide to the IDC to be calculated. If the following
additive formula is satisfied, then no further action is required:
Ci
GL
i
where:
Ci = the measured activity concentration of radionuclide i, and
GL = the guidance level (see Tables 9.2 and A6.1 in Annex 6) of radionuclide i
that, at an intake of 2 litres/day1 for 1 year, will result in an effective dose
of 0.1 mSv/year.
If any of the guidance levels is exceeded, then the sum will exceed unity. The
sum may also exceed unity even if none of the individual guidance levels is exceeded.
Where the sum exceeds unity for a single sample, the IDC of 0.1 mSv/year would be
exceeded only if the exposure to the same measured concentrations were to continue
for a full year. Hence, such a result does not in itself imply that the water is unsuitable for
consumption.
9.3.3 Strategy for assessing drinking-water if guidance levels are exceeded
An annual dose of 0.1 mSv is a small percentage of the average radiation dose received
by any individual. Both the screening levels and guidance levels are highly conservative values that allow national authorities to determine, without further consideration,
that the drinking-water is fit for consumption from a radiological viewpoint. National
experiences have shown that the vast majority of water supplies comply with these
criteria.
Occasionally, the situation may arise where the guidance levels are consistently
exceeded for one or a combination of specific radionuclides. National authorities will
then need to make a decision regarding the need to implement remedial measures
or to place some restriction on the continued use of the water supply for drinking
purposes.
From a radiological point of view, one of the key considerations is the extent to
which the guidance levels are exceeded. The International Basic Safety Standards for
Protection against Ionizing Radiation and for the Safety of Radiation Sources address
drinking-water in the chapter on existing exposure situations and contain a requirement that the highest annual individual doses received from the consumption of
1
Where national or regional consumption rates are known, the guidance level should be adjusted to take
this into account.
210
9. RADIOLOGICAL ASPECTS
Table 9.2 Guidance levels for commona natural and artificial radionuclides for members of the
public
Category
Radionuclide
Dose
coefficient
(Sv/Bq)
Guidance
level b
(Bq/l)
Uranium-238
4.5 108
10
Uranium-234
4.9 108
Thorium-230
2.1 107
Radium-226
2.8 10
Lead-210
6.9 10
0.1
0.1
Polonium-210
1.2 10
Thorium-232
2.3 107
Radium-228
6.9 107
0.1
Thorium-228
7.2 108
Caesium-134
1.9 10
10
1.3 10
10
Strontium-90
2.8 10
10
Iodine-131d,e
2.2 108
10
1.8 1011
10 000
Carbon-14
Naturally occurring radioactive isotope widely
distributed in nature and present in organic compounds
and in the human body
5.8 1010
100
Plutonium-239d
2.5 107
Americium-241d
2.0 107
Caesium-137
d
d
8
8
This list is not exhaustive. In certain circumstances, other radionuclides should be investigated (see Annex 6).
Guidance levels are rounded to the nearest order of magnitude.
c
Separate guidance levels are provided for individual uranium radioisotopes in terms of radioactivity (i.e. expressed as
Bq/l). The provisional guideline value for total content of uranium in drinking-water is 30 g/l based on its chemical
toxicity, which is predominant compared with its radiological toxicity (see chapter 12).
d
These radionuclides either may not occur in drinking-water in normal situations or may be found at doses that are too low
to be of significance to public health. Therefore, they are of lower priority for investigation following an exceedance of a
screening level.
e
Although iodine and tritium will not be detected by standard gross activity measurements and routine analysis for
these radionuclides is not necessary, if there are any reasons for believing that they may be present, radionuclidespecific sampling and measurement techniques should be used. This is the reason for including them in this table.
a
211
IAEA Safety Standards Series No. GSR Part 3, IAEA, Vienna (revised edition, in preparation).
212
9. RADIOLOGICAL ASPECTS
age-dependent dose coefficients for children are higher than those for adults, accounting for higher uptake or metabolic rates. In the case of prolonged contamination of
the water source, an assessment of doses to infants and children may be considered.
The guidance levels apply to routine (normal) operational conditions of existing
or new drinking-water supplies. They do not apply during an emergency exposure
situation involving the release of radionuclides into the environment. However, the
guidance levels apply again once the relevant authorities have declared an end to the
emergency exposure situation. Additional guidance is provided in section 6.7 and in
several publications (IAEA, 2002; IAEA & WHO, 2005, 2010; ICRP, 2009a).
The guidance levels for radionuclides in drinking-water were calculated using the
following equation:
IDC
hing q
GL =
where:
GL
IDC
hing
q
=
=
=
=
Table 9.3 Methods for the analysis of gross alpha and gross beta activities in drinking-water
Method (reference)
Technique
0.020.1 Bq/l
References for analytical methods for specific radionuclides are provided in Annex 6.
Information on measuring radon concentrations in water is provided in section 9.7.4.
9.7 Radon
9.7.1 Radon in air and water
Uranium, radium and radon are all soluble in water. Radon present in surface waters,
such as lakes and rivers, is readily released into outdoor air by agitation as it passes
214
9. RADIOLOGICAL ASPECTS
Element
Coagulation
Sand
filtration
Activated
carbon
Precipitation
softening
Ion
exchange
Reverse
osmosis
Strontium
xx
xx
xxxx
xxx
xxxx
Iodine
xx
xx
xxx
xxx
xxxx
Caesium
xx
xx
xx
xxx
xxxx
Radium
xx
xxx
xx
xxxx
xxxx
xxxx
Uranium
xxxx
xx
xxxx
xxxx
xxxx
Plutonium
xxxx
xx
xxx
xxxx
xxxx
Americium
xxxx
xx
xxx
xxxx
xxxx
Tritium
x = 010% removal; xx = 1040% removal; xxx = 4070% removal; xxxx = > 70% removal.
Some groundwater supplies may contain elevated concentrations of radon. High radon
concentrations are seldom found in surface drinking-water supplies.
Radon dissolved in drinking-water can be released into indoor air. Normally, a higher
radon dose is received from inhaling the radon and radon progeny compared with their
ingestion.
Radon released from drinking-water is not the only source of radon in indoor air.
Where high indoor radon concentrations exist, the underlying soil and building
materials, rather than the drinking-water, are normally the predominant sources.
Straightforward and effective techniques exist to reduce the concentration of radon in
drinking-water supplies.
In deciding whether or not to take steps to reduce the concentration of radon in
drinking-water supplies, it is important to take account of the contribution of other
sources of radon to the total radiation dose. Any action should be both justified and
optimized and take account of local conditions.
over rocks and soils. Groundwater from wells and boreholes usually contains higher
radon concentrations than surface waters. In some extreme circumstances, very high
radon concentrations can be found in drinking-water supplies from these sources (see
Box 9.5).
Radon is soluble in water, its solubility decreasing rapidly with an increase in temperature. When a tap or shower is turned on, some of the dissolved radon is released
into indoor air. This adds to the radon present from other sources and will give rise to
a radiation dose when inhaled.
An evaluation of international research data (UNSCEAR, 2000) has concluded
that, on average, 90% of the dose attributable to radon in drinking-water comes from
inhalation rather than ingestion. Therefore, controlling the inhalation pathway rather
than the ingestion pathway is the most effective way to control doses from radon in
drinking-water.
215
The percentage of radon present in drinking-water that is released into indoor air
will depend on local conditions, such as the total consumption of water in the house,
the volume of the house and its ventilation rate, and is likely to be highly variable. It
has been estimated that a radon concentration of 1000 Bq/l in drinking-water discharged from a tap or shower will, on average, increase the radon concentration by 100
Bq/m3 in indoor air (NAS, 1999; European Commission, 2001; Health Canada, 2009).
This contribution is not constant, as it occurs only while the water is being discharged
through the tap or shower. Radon in air also comes from other sources, in particular
radon entering the home from the underlying soil.
9.7.2 Health risks from radon
Epidemiological studies have clearly shown that long-term exposure to high radon
concentrations in indoor air increases the risk of lung cancer (WHO, 2009). Radon ingested in drinking-water will give a radiation dose to the lining of the stomach. Scientific studies have not shown a definitive link between consumption of drinking-water
containing radon and an increased risk of stomach cancer (Ye et al., 1998; Auvinen
et al., 2005; WHO, 2009).
9.7.3 Guidance on radon in drinking-water supplies
As the dose from radon present in drinking-water is normally received from inhalation rather than ingestion, it is more appropriate to measure the radon concentration
in air than in drinking-water.
The World Health Organization reference level for radon concentration in
indoor air is 100 Bq/m3 in dwellings. If this level cannot be reached under prevailing
country-specific conditions, the level should not exceed 300 Bq/m3, corresponding
to an annual dose of approximately 10 mSv (WHO, 2009). This recommendation is
consistent with the International Basic Safety Standards1 and with the most recent
recommendations of the ICRP (2009b).
Screening levels for radon in water should be set on the basis of the national reference level for radon in air and the distribution of radon in the national housing stock.
Where high radon concentrations are identified in indoor air, this is nearly always
due to ingress of radon from the soil rather than degassing from the drinking-water
supply. Nevertheless, in circumstances where high radon concentrations might be
expected in drinking-water, it is prudent to measure for radon and, if high concentrations are identified, consider whether measures to reduce the concentrations present
are justified.
The concentration of radon in groundwater supplies can vary considerably. Consequently, in situations where high radon concentrations have been identified or are
suspected, the frequency of gross alpha and gross beta measurements may need to be
increased so that the presence of radon progeny (in particular polonium-210), which
can be major contributors to dose, can be assessed and monitored on an ongoing basis.
1
International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of
Radiation Sources, IAEA Safety Standards Series No. GSR Part 3, IAEA, Vienna (revised edition, in
preparation).
216
9. RADIOLOGICAL ASPECTS
(e.g. placing possible health risks from ingestion of drinking-water in the context of
risk associated with exposure to natural radiation in different parts of the world). It
should be clearly explained that guidance levels should not be interpreted as mandatory limits and that exceeding a guidance level may be taken as a trigger for further
investigation, but it is not necessarily an indication that the drinking-water is unsafe.
The persons in charge of communicating risk should be skilled in interpersonal
communication, able to convey empathy, effective listeners and respectful of peoples
concerns. They should be knowledgeable about the topic area with which they are
dealing and be able to answer basic questions about the current as well as possible future risks. Guidance on radiation risk communication is provided elsewhere (USEPA,
2007; WHO, 2009).
218
10
Acceptability aspects:
Taste, odour and appearance
Introduction
(Chapter 1)
he provision of
FRAMEWORK FOR SAFE DRINKING-WATER
SUPPORTING
INFORMATION
drinking-water that
Public health context
Health-based targets
Microbial aspects
is not only safe but also
and health outcome
(Chapter 3)
(Chapters 7 and 11)
acceptable in appearChemical aspects
Water safety plans
ance, taste and odour is
(Chapters 8 and 12)
(Chapter 4)
of high priority. Water
Radiological
System
Management and
Monitoring
aspects
assessment
communication
that is aesthetically un(Chapter 9)
acceptable will underAcceptability
Surveillance
mine the confidence of
aspects
(Chapter 5)
(Chapter 10)
consumers, will lead to
complaints and, more
Application of the Guidelines
importantly, could lead
in specific circumstances
to the use of water from
(Chapter 6)
sources that are less safe.
Climate change, Emergencies,
Rainwater harvesting, Desalination
To a large extent,
systems, Travellers, Planes and
ships, etc.
consumers have no
means of judging the
safety of their drinking-water themselves, but their attitude towards their drinkingwater supply and their drinking-water suppliers will be affected to a considerable extent by the aspects of water
quality that they are able to perThe appearance, taste and odour of drinking-water
ceive with their own senses. It
should be acceptable to the consumer. Water that is
aesthetically unacceptable can lead to the use of water
is natural for consumers to refrom sources that are aesthetically more acceptable,
gard with suspicion water that
but potentially less safe.
appears dirty or discoloured or
that has an unpleasant taste or
smell, even though these characteristics may not in themselves be of direct consequence to health.
219
Some substances of health concern have effects on the taste, odour or appearance
of drinking-water that would normally lead to rejection of the water at concentrations
significantly lower than those of concern for health.
The concentration at which constituents are objecGuideline values have not
tionable to consumers is variable and dependent on
been established for constituindividual and local factors, including the quality of
ents influencing water quality
the water to which the community is accustomed
that have no direct link to adand a variety of social, environmental and cultural
verse health impacts.
considerations. Guideline values have not been established for constituents influencing water quality
that have no direct link to adverse health impacts. However, guideline values have been
established for some substances that may cause taste or odour in drinking-water at
much lower concentrations than the guideline value because there is such a wide range
in the ability of consumers to detect them by taste or odour. In the summaries in this
chapter and the fact sheets in chapter 12, reference is made to levels likely to give rise
to complaints from consumers. These are not precise numbers, and tastes or odours
may be detectable by consumers at lower or higher levels, depending on individual
and local circumstances.
It is important to consider whether existing or proposed water treatment and
distribution practices can affect the acceptability of drinking-water and to manage
change and operations to minimize the risk of problems for acceptability as well as
health. For example, chloramination that is not properly managed can lead to the
formation of trichloramines, which can cause unacceptable taste and odour. Other
problems may be indirect, such as the disturbance of internal pipe deposits and biofilms when the flow is disturbed or changed in distribution systems.
It is not normally appropriate to directly regulate or monitor substances of health
concern whose effects on the acceptability of water would normally lead to rejection
of the water at concentrations significantly lower than those of concern for health;
rather, these substances may be addressed through a general requirement that water be
acceptable to the majority of consumers. For such substances, a formal guideline value
is not usually derived, but a health-based value is derived in order to assist in judging
the response that is needed when problems are encountered and in some cases to provide reassurance to health authorities and consumers with regard to possible health
risks. In the fact sheets in chapter 12, this is explained, and information on acceptability is described. In the tables of guideline values (see chapter 8 and Annex 3), for
those chemicals for which health-based guideline values were derived, the guideline
value is designated with a C, with a footnote explaining that while the substance is of
health significance, water would normally be rejected by consumers at concentrations
well below the health-based guideline value. Monitoring of such substances should be
undertaken in response to consumer complaints.
Taste and odour can originate from natural inorganic and organic chemical contaminants and biological sources or processes (e.g. aquatic microorganisms), from
contamination by synthetic chemicals, from corrosion or as a result of problems with
water treatment (e.g. chlorination). Taste and odour may also develop during storage
and distribution as a result of microbial activity.
220
The section was drawn largely from chapter 6 of the supporting document Safe piped water (Annex 1).
221
louse [Asellus aquaticus], snails, zebra mussel [Dreissena polymorpha], other bivalve
molluscs and the bryozoan Plumatella sp.) or inhabit slimes (e.g. Nais spp., nematodes
and the larvae of chironomids). In warm weather, slow sand filters can sometimes
discharge the larvae of gnats (Chironomus and Culex spp.) into the water. In certain
circumstances, these can reproduce parthenogenetically (i.e. asexual reproduction),
which can exacerbate the problem in service reservoirs and distribution.
Many of these invertebrates can survive, deriving food from bacteria, algae and
protozoa in the water or present on slimes on pipe and tank surfaces. Few water distribution systems are completely free of animals at all times. However, the density and
composition of invertebrate populations vary widely, from heavy infestations, including readily visible species that are objectionable to consumers, to sparse occurrences
of microscopic species.
The presence of invertebrates has largely been regarded by piped drinking-water
suppliers in temperate regions as an acceptability problem, either directly or through
their association with discoloured water. Large invertebrate populations also indicate
high levels of organic material that may give rise to other water quality issues, such as
microbial growth. In tropical and subtropical countries, in contrast, there are species
of aquatic invertebrates that act as secondary hosts for parasites. For example, the
small crustacean Cyclops is the intermediate host of the guinea worm (Dracunculus
medinensis) (see sections 7.1.1 and 11.4). However, there is no evidence that guinea
worm transmission occurs from piped drinking-water supplies. The presence of invertebrates in drinking-water, especially if visible, raises consumer concern about the
quality of the drinking-water supply and should be controlled.
Penetration of waterworks and mains is more likely to be a problem when highrate filtration processes are used, but problems can arise even at well-run treatment
works. Regular cleaning of water mains by flushing and/or swabbing will usually control infestation.
Treatment of invertebrate infestations in piped distribution systems is discussed
in detail in chapter 6 of the supporting document Safe piped water (Annex 1).
Iron bacteria
In waters containing ferrous and manganous salts, oxidation by iron bacteria (or by
exposure to air) may cause rust-coloured deposits on the walls of tanks, pipes and
channels and carry-over of deposits into the water.
than 0.1 mg/l are achievable in many circumstances. Available evidence does not support the derivation of a health-based guideline value for aluminium in drinking-water
(see sections 8.5.4 and 12.1).
Ammonia
The threshold odour concentration of ammonia at alkaline pH is approximately 1.5
mg/l, and a taste threshold of 35 mg/l has been proposed for the ammonium cation. Ammonia is not of direct relevance to health at these levels, and no health-based
guideline value has been proposed (see sections 8.5.3 and 12.1). However, ammonia
does react with chlorine to reduce free chlorine and to form chloramines.
Chloramines
Chloramines, such as monochloramine, dichloramine and trichloramine (nitrogen
trichloride), are generated from the reaction of chlorine with ammonia. Among
chloramines, monochloramine is the only useful chlorine disinfectant, and
chloramination systems are operated to minimize the formation of dichloramine and
trichloramine. Higher chloramines, particularly trichloramine, are likely to give rise to
taste and odour complaints, except at very low concentrations.
For monochloramine, no odour or taste was detected at concentrations between
0.5 and 1.5 mg/l. However, slight organoleptic effects within this range and odour
and taste thresholds of 0.65 and 0.48 mg/l have been reported. For dichloramine, the
organoleptic effects between 0.1 and 0.5 mg/l were found to be slight and acceptable. Odour and taste thresholds of 0.15 and 0.13 mg/l were reported, respectively.
An odour threshold of 0.02 mg/l has been reported for trichloramine, and it has been
described as geranium.
A guideline value for monochloramine has been established (see sections 8.5.4
and 12.1).
Chloride
High concentrations of chloride give a salty taste to water and beverages. Taste thresholds for the chloride anion depend on the associated cation and are in the range of
200300 mg/l for sodium, potassium and calcium chloride. Concentrations in excess
of 250 mg/l are increasingly likely to be detected by taste, but some consumers may
become accustomed to low levels of chloride-induced taste. No health-based guideline
value is proposed for chloride in drinking-water (see sections 8.5.1 and 12.1).
Chlorine
Most individuals are able to taste or smell chlorine in drinking-water at concentrations well below 5 mg/l, and some at levels as low as 0.3 mg/l. The taste threshold
for chlorine is below the health-based guideline value of 5 mg/l (see sections 8.5.4
and 12.1).
Chlorobenzenes
Taste and odour thresholds of 1020 g/l and odour thresholds ranging from 40 to
120 g/l have been reported for monochlorobenzene. A health-based guideline value
223
has not been derived for monochlorobenzene (see sections 8.5.2 and 12.1), although
the health-based value that could be derived far exceeds the lowest reported taste and
odour threshold in water.
Odour thresholds of 210 and 0.330 g/l have been reported for 1,2- and 1,4dichlorobenzene, respectively. Taste thresholds of 1 and 6 g/l have been reported for
1,2- and 1,4-dichlorobenzene, respectively. The health-based guideline values of 1
mg/l derived for 1,2-dichlorobenzene and of 0.3 mg/l for 1,4-dichlorobenzene (see
sections 8.5.2 and 12.1) far exceed the lowest reported taste and odour thresholds for
these compounds.
Odour thresholds of 10, 530 and 50 g/l have been reported for 1,2,3-, 1,2,4- and
1,3,5-trichlorobenzene, respectively. A taste and odour threshold concentration of 30 g/l
has been reported for 1,2,4-trichlorobenzene. A health-based guideline value was not derived for trichlorobenzenes, although the health-based value that could be derived (see
sections 8.5.2 and 12.1) exceeds the lowest reported odour threshold in water of 5 g/l.
Chlorophenols
Chlorophenols generally have very low taste and odour thresholds. The taste thresholds in water for 2-chlorophenol, 2,4-dichlorophenol and 2,4,6-trichlorophenol are
0.1, 0.3 and 2 g/l, respectively. Odour thresholds are 10, 40 and 300 g/l, respectively.
If water containing 2,4,6-trichlorophenol is free from taste, it is unlikely to present a
significant risk to health (see sections 8.5.4 and 12.1). Microorganisms in distribution
systems may sometimes methylate chlorophenols to produce chlorinated anisoles, for
which the odour threshold is considerably lower.
Colour
Drinking-water should ideally have no visible colour. Colour in drinking-water is usually due to the presence of coloured organic matter (primarily humic and fulvic acids)
associated with the humus fraction of soil. Colour is also strongly influenced by the
presence of iron and other metals, either as natural impurities or as corrosion products. It may also result from the contamination of the water source with industrial
effluents and may be the first indication of a hazardous situation. The source of colour
in a drinking-water supply should be investigated, particularly if a substantial change
has taken place.
Most people can detect colour above 15 true colour units (TCU) in a glass of
water. Levels of colour below 15 TCU are often acceptable to consumers. High colour
from natural organic carbon (e.g. humics) could also indicate a high propensity to
produce by-products from disinfection processes. No health-based guideline value is
proposed for colour in drinking-water.
Copper
Copper in a drinking-water supply usually arises from the corrosive action of water
leaching copper from copper pipes in buildings. High levels of dissolved oxygen have
been shown to accelerate copper corrosion in some cases. Concentrations can vary
significantly with the period of time the water has been standing in contact with the
pipes; for example, first-draw water would be expected to have a higher copper con224
centration than a fully flushed sample. High concentrations can interfere with the
intended domestic uses of the water. Staining of sanitary ware and laundry may occur
at copper concentrations above 1 mg/l. At levels above 5 mg/l, copper also imparts a
colour and an undesirable bitter taste to water. Although copper can give rise to taste,
it should be acceptable at the health-based guideline value of 2 mg/l (see sections 8.5.4,
12.1 and A5.3 in Annex 5).
Dissolved oxygen
The dissolved oxygen content of water is influenced by the source, raw water temperature, treatment and chemical or biological processes taking place in the distribution system. Depletion of dissolved oxygen in water supplies can encourage the
microbial reduction of nitrate to nitrite and sulfate to sulfide. It can also cause an
increase in the concentration of ferrous iron in solution, with subsequent discoloration at the tap when the water is aerated. No health-based guideline value is recommended. However, very high levels of dissolved oxygen may exacerbate corrosion of
metal pipes.
Ethylbenzene
Ethylbenzene has an aromatic odour; the reported odour threshold in water ranges
from 2 to 130 g/l. The lowest reported odour threshold is 100-fold lower than the
health-based guideline value of 0.3 mg/l (see sections 8.5.2 and 12.1). The taste threshold ranges from 72 to 200 g/l.
Hardness
Hardness caused by calcium and magnesium is usually indicated by precipitation of
soap scum and the need for excess use of soap to achieve cleaning. Consumers are
likely to notice changes in hardness. Public acceptability of the degree of hardness of
water may vary considerably from one community to another. The taste threshold for
the calcium ion is in the range of 100300 mg/l, depending on the associated anion,
and the taste threshold for magnesium is probably lower than that for calcium. In
some instances, consumers tolerate water hardness in excess of 500 mg/l.
Depending on the interaction of other factors, such as pH and alkalinity, water
with a hardness above approximately 200 mg/l may cause scale deposition in the treatment works, distribution system and pipework and tanks within buildings. It will also
result in high soap consumption and subsequent scum formation. On heating, hard
waters form deposits of calcium carbonate scale. Soft water, but not necessarily cation
exchange softened water, with a hardness of less than 100 mg/l may, in contrast, have
a low buffering capacity and so be more corrosive for water pipes.
No health-based guideline value is proposed for hardness in drinking-water (see
the supporting document Calcium and magnesium in drinking-water; Annex 1).
Hydrogen sulfide
The taste and odour thresholds of hydrogen sulfide in water are estimated to be between 0.05 and 0.1 mg/l. The rotten eggs odour of hydrogen sulfide is particularly
225
cessary at all stages of water treatment to ensure satisfactory water clarification and
disinfection (see the supporting document Safe piped water; Annex 1). For effective
disinfection with chlorine, the pH should preferably be less than 8; however, lower-pH water (approximately pH 7 or less) is more likely to be corrosive. The pH of
the water entering the distribution system must be controlled to minimize the corrosion of water mains and pipes in household water systems. Alkalinity and calcium
management also contribute to the stability of water and control its aggressiveness to
pipes and appliances. Failure to minimize corrosion can result in the contamination
of drinking-water and in adverse effects on its taste and appearance. The optimum
pH required will vary in different supplies according to the composition of the water
and the nature of the construction materials used in the distribution system, but it is
usually in the range 6.58.5 (see section 8.4.3). Extreme values of pH can result from
accidental spills, treatment breakdowns and insufficiently cured cement mortar pipe
linings or cement mortar linings applied when the alkalinity of the water is low. No
health-based guideline value has been proposed for pH (see section 12.1).
Sodium
The taste threshold concentration of sodium in water depends on the associated anion
and the temperature of the solution. At room temperature, the average taste threshold
for sodium is about 200 mg/l. No health-based guideline value has been derived (see
sections 8.5.1 and 12.1), as the contribution from drinking-water to daily intake is
small.
Styrene
Styrene has a sweet/sickly odour, and reported odour thresholds for styrene in water
range from 0.004 to 2.6 mg/l, depending on temperature. Styrene may therefore be
detected in water at concentrations below its health-based guideline value of 0.02 mg/l
(see sections 8.5.2 and 12.1).
Sulfate
The presence of sulfate in drinking-water can cause noticeable taste, and very high
levels might cause a laxative effect in unaccustomed consumers. Taste impairment
varies with the nature of the associated cation; taste thresholds have been found to
range from 250 mg/l for sodium sulfate to 1000 mg/l for calcium sulfate. It is generally
considered that taste impairment is minimal at levels below 250 mg/l. No health-based
guideline value has been derived for sulfate (see sections 8.5.1 and 12.1).
Synthetic detergents
In many countries, persistent types of anionic detergent have been replaced by others
that are more easily biodegraded, and hence the levels found in water sources have
decreased substantially. The concentration of detergents in drinking-water should not
be allowed to reach levels giving rise to either foaming or taste problems. The presence
of any detergent may indicate contamination of source water with sewage or ingress of
detergent solution into the distribution system, as a result of back-flow, for example.
227
Toluene
Toluene has a sweet, pungent, benzene-like odour. The reported taste threshold ranges
from 0.04 to 0.12 mg/l. The reported odour threshold for toluene in water ranges
from 0.024 to 0.17 mg/l. Toluene may therefore affect the acceptability of water at
concentrations below its health-based guideline value of 0.7 mg/l (see sections 8.5.2
and 12.1).
Total dissolved solids
The palatability of water with a total dissolved solids (TDS) level of less than about
600 mg/l is generally considered to be good; drinking-water becomes significantly and
increasingly unpalatable at TDS levels greater than about 1000 mg/l. The presence of
high levels of TDS may also be objectionable to consumers, owing to excessive scaling
in water pipes, heaters, boilers and household appliances. No health-based guideline
value for TDS has been proposed (see sections 8.5.1 and 12.1).
Turbidity
Turbidity in water is caused by suspended particles or colloidal matter that obstructs
light transmission through the water. It may be caused by inorganic or organic matter
or a combination of the two. Microorganisms (bacteria, viruses and protozoa) are typically attached to particulates, and removal of turbidity by filtration will significantly
reduce microbial contamination in treated water. Turbidity in some groundwater
sources is a consequence of inert clay or chalk particles or the precipitation of nonsoluble reduced iron and other oxides when water is pumped from anaerobic waters,
whereas turbidity in surface waters may be the result of particulate matter of many
types and is more likely to include attached microorganisms that are a threat to health.
Turbidity in distribution systems can occur as a result of the disturbance of sediments
and biofilms but is also from the ingress of dirty water from outside the system.
In addition, turbidity can seriously interfere with the efficiency of disinfection by
providing protection for organisms, and much of water treatment is directed at removal of particulate matter before disinfection. This not only will increase the efficacy
of disinfection by chemical disinfectants such as chlorine and ozone, but is an essential
step in ensuring the effectiveness of physical disinfection processes such as ultraviolet
irradiation, because light transmission through water is impaired by particulates.
Removal of particulate matter by coagulation and sedimentation and by filtration
is an important barrier in achieving safe drinking-water. Achieving low turbidity by
filtration (before disinfection) of water from surface sources and groundwaters where
raised turbidity occursfor instance, where these are under the influence of surface
watersis strongly recommended to ensure microbially safe water.
Turbidity can also have a negative impact on consumer acceptability of water as a
result of visible cloudiness. Although turbidity per se (e.g. from groundwater minerals
or from post-precipitation of calcium carbonate from lime treatment) is not necessarily a threat to health, it is an important indicator of the possible presence of contaminants that would be of concern for health, especially from inadequately treated
or unfiltered surface water. Data are emerging that show an increasing risk of gastro228
intestinal infections that correlates with high turbidity and turbidity events in distribution. This may be because turbidity is acting as an indicator of possible sources of
microbial contamination. Therefore, turbidity events should be investigated and the
causes corrected, whereas turbidity should be minimized as far as is possible within
the constraints of the type of system and the resources available as one part of the
management of distribution to achieve water safety. Turbidity is also an important
consideration when investment decisions are made regarding sources and treatment
for water supplies and should be identified in the water safety plan as a hazard that
needs to be controlled.
Turbidity is measured by nephelometric turbidity units (NTU) and can be initially noticed by the naked eye above approximately 4.0 NTU. However, to ensure
effectiveness of disinfection, turbidity should be no more than 1 NTU and preferably
much lower. Large, well-run municipal supplies should be able to achieve less than 0.5
NTU before disinfection at all times and should be able to average 0.2 NTU or less.
Surface water (and groundwater under the influence of surface water) treatment systems that achieve less than 0.3 NTU prior to disinfection will have demonstrated that
they have significant barriers against pathogens that adsorb to particulate matter. Of
particular importance is the fact that this will be a good indicator that they are removing chlorine-resistant pathogens such as Cryptosporidium.
Small water supplies where resources are very limited and where there is limited
or no treatment may not be able to achieve such low levels of turbidity. In these cases,
the aim should be to produce water that has turbidity of at least less than 5 NTU and,
if at all possible, below 1 NTU. For many of these small and usually rural supplies,
measuring turbidity below 5 NTU may present a significant cost challenge, and thus
providing low-cost measuring systems that can measure lower turbidities is an important requirement.
Occasionally, turbidity can be caused by minute air bubbles released when water
has a high dissolved air content. Such turbidity clears rapidly upwards through the
surface but can cause concern for consumers, and efforts should be made to manage
distribution systems to ensure that this does not happen.
Xylenes
Xylene concentrations in the range of 0.3 mg/l produce a detectable taste and odour.
The odour threshold for xylene isomers in water has been reported to range from 0.02
to 1.8 mg/l. The lowest odour threshold is well below the health-based guideline value
of 0.5 mg/l for xylene (see sections 8.5.2 and 12.1).
Zinc
Zinc imparts an undesirable astringent taste to water at a taste threshold concentration of about 4 mg/l (as zinc sulfate). Water containing zinc at concentrations in excess
of 35 mg/l may appear opalescent and develop a greasy film on boiling. Although
drinking-water seldom contains zinc at concentrations above 0.1 mg/l, levels in tap
water can be considerably higher because of the zinc used in older galvanized plumbing materials; this may also be an indicator of elevated cadmium from such older
229
material. No health-based guideline value has been proposed for zinc in drinkingwater (see sections 8.5.4 and 12.1).
10.4 Temperature
Cool water is generally more palatable than warm water, and temperature will have an
impact on the acceptability of a number of other inorganic constituents and chemical
contaminants that may affect taste. High water temperature enhances the growth of
microorganisms and may increase problems related to taste, odour, colour and corrosion.
230
11
Microbial fact sheets
Introduction
(Chapter 1)
Health-based targets
(Chapter 3)
Monitoring
Management and
communication
Surveillance
(Chapter 5)
SUPPORTING
INFORMATION
Microbial aspects
(Chapters 7 and 11)
Chemical aspects
(Chapters 8 and 12)
Radiological
aspects
(Chapter 9)
Acceptability
aspects
(Chapter 10)
bacteria, viruses,
protozoa and helApplication of the Guidelines
minths identified in
in specific circumstances
(Chapter 6)
Table 7.1 and Figure
Climate
change,
Emergencies,
7.1, with the excepRainwater harvesting, Desalination
systems, Travellers, Planes and
tion of Schistosoma,
ships, etc.
which is primarily
spread by contact
with contaminated surface water during bathing and washing;
potentially emerging pathogens, including Helicobacter pylori, Tsukamurella, Isospora belli and microsporidia, for which waterborne transmission is plausible but
unconfirmed;
Bacillus, which includes the foodborne pathogenic species Bacillus cereus but for
which there is no evidence at this time of waterborne transmission;
hazardous cyanobacteria.
231
pathogens, however, there are other important sources of infection, such as person-toperson contact and food.
Most waterborne pathogens are introduced into drinking-water supplies in human or animal faeces, do not grow in water and initiate infection in the gastrointestinal tract following ingestion. However, Legionella, atypical mycobacteria, Burkholderia
pseudomallei, Acanthamoeba spp. and Naegleria fowleri are environmental organisms
that can grow in water and soil. Besides ingestion, other routes of transmission can
include inhalation, leading to infections of the respiratory tract (e.g. Legionella, atypical mycobacteria), and contact, leading to infections at sites as diverse as the skin and
brain (e.g. Naegleria fowleri, Burkholderia pseudomallei).
Of all the waterborne pathogens, the helminth Dracunculus medinensis is unique
in that it is the only pathogen that is solely transmitted through drinking-water.
The fact sheets on potential pathogens include information on human health effects, sources and occurrence, routes of transmission and the significance of drinkingwater as a source of infection. The fact sheets on microorganisms that can be used
as indicators of the effectiveness of control measures or of the potential presence of
pathogenic microorganisms provide information on indicator value, source and occurrence, application and significance of detection.
232
233
Aeromonas
General description
Aeromonas spp. are Gram-negative, non-spore-forming, facultative anaerobic bacilli
belonging to the family Vibrionaceae. They bear many similarities to the Enterobacteriaceae. The genus is divided into two groups. The group of psychrophilic non-motile
aeromonads consists of only one species, A. salmonicida, an obligate fish pathogen
that is not considered further here. The group of mesophilic motile (single polar flagellum) aeromonads is considered of potential human health significance and consists
of the species A. hydrophila, A. caviae, A. veronii subsp. sobria, A. jandaei, A. veronii
subsp. veronii and A. schubertii. The bacteria are normal inhabitants of fresh water and
occur in water, soil and many foods, particularly meat and milk.
Human health effects
Aeromonas spp. can cause infections in humans, including septicaemia, particularly
in immunocompromised patients, wound infections and respiratory tract infections.
There have been some claims that Aeromonas spp. can cause gastrointestinal illness,
but epidemiological evidence is not consistent. Despite marked toxin production by
Aeromonas spp. in vitro, diarrhoea has not yet been introduced in test animals or human volunteers.
Source and occurrence
Aeromonas spp. occur in water, soil and food, particularly meat, fish and milk. Aeromonas spp. are generally readily found in most fresh waters, and they have been detected in many treated drinking-water supplies, mainly as a result of regrowth in distribution systems. The factors that affect the occurrence of Aeromonas spp. in water
distribution systems are not fully understood, but organic content, temperature, the
residence time of water in the distribution network and the presence of residual chlorine have been shown to influence population sizes.
Routes of exposure
Wound infections have been associated with contaminated soil and water-related activities, such as swimming, diving, boating and fishing. Septicaemia can follow from
such wound infections. In immunocompromised individuals, septicaemia may arise
from aeromonads present in their own gastrointestinal tract.
234
Significance in drinking-water
Despite frequent isolation of Aeromonas spp. from drinking-water, the body of
evidence does not provide significant support for waterborne transmission. Aeromonads typically found in drinking-water do not belong to the same deoxyribonucleic
acid (DNA) homology groups as those associated with cases of gastroenteritis. The
presence of Aeromonas spp. in drinking-water supplies is generally considered a nuisance. Entry of aeromonads into distribution systems can be minimized by adequate
disinfection. Control measures that can limit growth of the bacteria in distribution
systems include treatment to optimize organic carbon removal, restriction of the residence time of water in distribution systems and maintenance of disinfectant residuals.
Aeromonas spp. are detected by HPC, which can be used together with parameters
such as disinfectant residuals to indicate conditions that could support growth of
these organisms. However, E. coli (or, alternatively, thermotolerant coliforms) cannot
be used as an indicator for the presence/absence of Aeromonas spp.
Selected bibliography
Bartram J et al., eds (2003) Heterotrophic plate counts and drinking-water safety: The significance
of HPCs for water quality and human health. London, IWA Publishing (WHO Emerging
Issues in Water and Infectious Disease Series).
Borchardt MA, Stemper ME, Standridge JH (2003) Aeromonas isolates from human diarrheic
stool and groundwater compared by pulsed-field gel electrophoresis. Emerging Infectious
Diseases, 9:224228.
WHO (2002) Aeromonas. In: Guidelines for drinking-water quality, 2nd ed. Addendum:
Microbiological agents in drinking water. Geneva, World Health Organization.
Bacillus
General description
Bacillus spp. are large (410 m), Gram-positive, strictly aerobic or facultatively anaerobic encapsulated bacilli. They have the important feature of producing spores that
are exceptionally resistant to unfavourable conditions. Bacillus spp. are classified into
the subgroups B. polymyxa, B. subtilis (which includes B. cereus and B. licheniformis),
B. brevis and B. anthracis.
Human health effects
Although most Bacillus spp. are harmless, a few are pathogenic to humans and animals. Bacillus cereus causes food poisoning similar to staphylococcal food poisoning.
Some strains produce heat-stable toxin in food that is associated with spore germination and gives rise to a syndrome of vomiting within 15 hours of ingestion. Other
strains produce a heat-labile enterotoxin after ingestion that causes diarrhoea within
1015 hours. Bacillus cereus is known to cause bacteraemia in immunocompromised
patients as well as symptoms such as vomiting and diarrhoea. Bacillus anthracis causes
anthrax in humans and animals.
Source and occurrence
Bacillus spp. commonly occur in a wide range of natural environments, such as soil
and water. They form part of the HPC bacteria, which are readily detected in most
drinking-water supplies.
235
Routes of exposure
Infection with Bacillus spp. is associated with the consumption of a variety of foods,
especially rice, pastas and vegetables, as well as raw milk and meat products. Disease
may result from the ingestion of the organisms or toxins produced by the organisms.
Drinking-water has not been identified as a source of infection of pathogenic Bacillus
spp., including Bacillus cereus. Waterborne transmission of Bacillus gastroenteritis has
not been confirmed.
Significance in drinking-water
Bacillus spp. are often detected in drinking-water supplies, even supplies treated and
disinfected by acceptable procedures. This is largely due to the resistance of spores to
disinfection processes. Owing to a lack of evidence that waterborne Bacillus spp. are
clinically significant, specific management strategies are not required.
Selected bibliography
Bartram J et al., eds (2003) Heterotrophic plate counts and drinking-water safety: The significance
of HPCs for water quality and human health. London, IWA Publishing (WHO Emerging
Issues in Water and Infectious Disease Series).
Burkholderia pseudomallei
General description
Burkholderia pseudomallei is a Gram-negative bacillus commonly found in soil and
muddy water, predominantly in tropical regions such as northern Australia and southeast Asia. The organism is acid tolerant and survives in water for prolonged periods in
the absence of nutrients.
Human health effects
Burkholderia pseudomallei can cause the disease melioidosis, which is endemic in
northern Australia and other tropical regions. The most common clinical manifestation is pneumonia, which may be fatal. In some of these areas, melioidosis is the most
common cause of community-acquired pneumonia. Cases appear throughout the
year but peak during the rainy season. Many patients present with milder forms of
pneumonia, which respond well to appropriate antibiotics, but some may present with
a severe septicaemic pneumonia. Other symptoms include skin abscesses or ulcers,
abscesses in internal organs and unusual neurological illnesses, such as brainstem encephalitis and acute paraplegia. Although melioidosis can occur in healthy children
and adults, it occurs mainly in people whose defence mechanisms against infection
are impaired by underlying conditions or poor general health associated with poor
nutrition or living conditions.
Source and occurrence
The organism occurs predominantly in tropical regions, typically in soil or surfaceaccumulated muddy water, from where it may reach raw water sources and also drinking-water supplies. The number of organisms in drinking-water that would constitute
a significant risk of infection is not known.
236
Routes of exposure
Most infections appear to be through contact of skin cuts or abrasions with contaminated water. In south-east Asia, rice paddies represent a significant source of infection.
Infection may also occur via other routes, particularly through inhalation or ingestion. The relative importance of these routes of infection is not known.
Significance in drinking-water
In two Australian outbreaks of melioidosis, indistinguishable isolates of B. pseudomallei were cultured from cases and the drinking-water supply. The detection of the
organisms in one drinking-water supply followed replacement of water pipes and
chlorination failure, whereas the second supply was unchlorinated. Within a water
safety plan, control measures that should provide effective protection against this
organism include application of established treatment and disinfection processes for
drinking-water coupled with protection of the distribution system from contamination, including during repairs and maintenance. HPC and disinfectant residual
as measures of water treatment effectiveness and application of appropriate mains
repair procedures could be used to indicate protection against B. pseudomallei. Because of the environmental occurrence of B. pseudomallei, E. coli (or, alternatively,
thermotolerant coliforms) is not a suitable indicator for the presence/absence of this
organism.
Selected bibliography
Ainsworth R, ed. (2004) Safe piped water: Managing microbial water quality in piped distribution
systems. IWA Publishing, London, for the World Health Organization, Geneva.
Currie BJ (2000) The epidemiology of melioidosis in Australia and Papua New Guinea. Acta
Tropica, 74:121127.
Currie BJ et al. (2001) A cluster of melioidosis cases from an endemic region is clonal and is
linked to the water supply using molecular typing of Burkholderia pseudomallei isolates.
American Journal of Tropical Medicine and Hygiene, 65:177179.
Inglis TJJ et al. (2000) Outbreak strain of Burkholderia pseudomallei traced to water treatment
plant. Emerging Infectious Diseases, 6:5659.
Campylobacter
General description
Campylobacter spp. are microaerophilic (require decreased oxygen) and capnophilic
(require increased carbon dioxide), Gram-negative, curved spiral rods with a single
unsheathed polar flagellum. Campylobacter spp. are one of the most important causes
of acute gastroenteritis worldwide. Campylobacter jejuni is the most frequently isolated species from patients with acute diarrhoeal disease, whereas C. coli, C. laridis
and C. fetus have also been isolated in a small proportion of cases. Two closely related
genera, Helicobacter and Archobacter, include species previously classified as Campylobacter spp.
Human health effects
An important feature of C. jejuni is relatively high infectivity compared with other
bacterial pathogens. As few as 1000 organisms can cause infection. Most symptomatic
237
infections occur in infancy and early childhood. The incubation period is usually 24
days. Clinical symptoms of C. jejuni infection are characterized by abdominal pain,
diarrhoea (with or without blood or faecal leukocytes), vomiting, chills and fever. The
infection is self-limited and resolves in 37 days. Relapses may occur in 510% of
untreated patients. Other clinical manifestations of C. jejuni infections in humans include reactive arthritis and meningitis. Several reports have associated C. jejuni infection with Guillain-Barr syndrome, an acute demyelinating disease of the peripheral
nerves.
Source and occurrence
Campylobacter spp. occur in a variety of environments. Wild and domestic animals,
especially poultry, wild birds and cattle, are important reservoirs. Pets and other animals may also be reservoirs. Food, including meat and unpasteurized milk, are important sources of Campylobacter infections. Water is also a significant source. The
occurrence of the organisms in surface waters has proved to be strongly dependent on
rainfall, water temperature and the presence of waterfowl.
Routes of exposure
Most Campylobacter infections are reported as sporadic in nature, with food considered a common source of infection. Transmission to humans typically occurs by
the consumption of animal products. Meat, particularly poultry products, and unpasteurized milk are important sources of infection. Contaminated drinking-water
supplies have been identified as a source of outbreaks. The number of cases in these
outbreaks ranged from a few to several thousand, with sources including unchlorinated or inadequately chlorinated surface water supplies and faecal contamination of
water storage reservoirs by wild birds.
Significance in drinking-water
Contaminated drinking-water supplies have been identified as a significant source of
outbreaks of campylobacteriosis. The detection of waterborne outbreaks and cases
appears to be increasing. Waterborne transmission has been confirmed by the isolation of the same strains from patients and drinking-water they had consumed. Within
a water safety plan, control measures that can be applied to manage potential risk
from Campylobacter spp. include protection of raw water supplies from waste from
humans and animals, adequate treatment and protection of water during distribution. Storages of treated and disinfected water should be protected from bird faeces.
Campylobacter spp. are faecally borne pathogens and are not particularly resistant to
disinfection. Hence, E. coli (or thermotolerant coliforms) is an appropriate indicator
for the presence/absence of Campylobacter spp. in drinking-water supplies.
Selected bibliography
Frost JA (2001) Current epidemiological issues in human campylobacteriosis. Journal of Applied
Microbiology, 90:85S95S.
Koenraad PMFJ, Rombouts FM, Notermans SHW (1997) Epidemiological aspects of
thermophilic Campylobacter in water-related environments: A review. Water Environment
Research, 69:5263.
238
Enterobacter sakazakii
General description
Enterobacter sakazakii is a motile, Gram-negative, non-spore-forming, rod-shaped
bacterium that has been found in infant formulas as a contaminant. Enterobacter species are biochemically similar to Klebsiella; unlike Klebsiella, however, Enterobacter is
ornithine positive. Enterobacter sakazakii has been found to be more resistant to osmotic and dry stress than other members of the Enterobacteriaceae family.
Human health effects
Enterobacter sakazakii has been associated with sporadic cases or small outbreaks of
sepsis, meningitis, cerebritis and necrotizing enterocolitis. Most of the infections are
seen in low-birth-weight infants (i.e. less than 2 kg) or infants born prematurely (i.e.
less than 37 weeks of gestation). Mortality has been reported to be as high as 50% but
has decreased to less than 20% in recent years.
Source and occurrence
The reservoir for E. sakazakii is unknown. Various environmental samples (surface
water, soil, mud, bird faeces) have tested negative. Enterobacter sakazakii has been
identified in the guts of certain flies. The organism has been frequently identified in
factories that produce milk powder and other food substances and in households.
Commercially produced non-sterile powdered infant formula has often been implicated as the source of the bacteria during outbreaks. In a study of 141 powdered infant formulas, 20 were found to be culture-positive for E. sakazakii, even though the
formulas complied with Codex microbial requirements for coliforms (< 3 colonyforming units per gram). The bacteria have been found in samples from newly opened
sealed cans. Although sources of the bacteria other than infant formula have not been
identified, environmental sources probably exist.
Routes of exposure
Disease caused by E. sakazakii in infants has been associated with the consumption
of commercially prepared non-sterile infant formula. Contamination has been linked
back to either the infant formula itself or formula preparation equipment (e.g. blenders). Many of the outbreaks have occurred without identified hygienic lapses during
formula preparation. The organism has not been found in drinking-water sources
used to prepare the formula. There is no evidence for person-to-person or more general environmental transmission.
Significance in drinking-water
There is no evidence that these bacteria are transmitted through drinking-water, although it is plausible that the organism could be present in water of poor quality.
Enterobacter sakazakii is sensitive to disinfectants, and its presence can be prevented
by adequate treatment.
239
Selected bibliography
Block C et al. (2002) Cluster of neonatal infections in Jerusalem due to unusual biochemical
variant of Enterobacter sakazakii. European Journal of Microbiology and Infectious Disease,
21:613616.
Breeuwer P et al. (2003) Desiccation and heat tolerance of Enterobacter sakazakii. Journal of
Applied Microbiology, 95:967973.
Hamilton JV, Lehane MJ, Braig HR (2003) Isolation of Enterobacter sakazakii from midgut of
Stomoxys calcitrans [letter to the editor]. Emerging Infectious Diseases, 9(10):13551356.
Kandhai CM et al. (2004) Occurrence of Enterobacter sakazakii in food production environments
and households [research letters]. Lancet, 363:3940.
WHO/FAO (2004) Enterobacter sakazakii and other microorganisms in powdered infant formula,
meeting report. Geneva, World Health Organization and Food and Agriculture Organization
of the United Nations (Microbiological Risk Assessment Series 6).
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Helicobacter pylori
General description
Helicobacter pylori, originally classified as Campylobacter pylori, is a Gram-negative,
microaerophilic, spiral-shaped, motile bacterium. There are at least 14 species of
Helicobacter, but only H. pylori has been identified as a human pathogen.
Human health effects
Helicobacter pylori is found in the stomach; although most infections are asymptomatic, the organism is associated with chronic gastritis, which may lead to complications
such as peptic and duodenal ulcer disease and gastric cancer. Whether the organism
241
is truly the cause of these conditions remains unclear. The majority of H. pylori infections are initiated in childhood and without treatment are chronic. The infections are
more prevalent in developing countries and are associated with overcrowded living
conditions. Interfamilial clustering is common.
Source and occurrence
Humans appear to be the primary host of H. pylori. Other hosts may include domestic
cats. There is evidence that H. pylori is sensitive to bile salts, which would reduce the
likelihood of faecal excretion, although it has been isolated from faeces of young children. Helicobacter pylori has been detected in water. Although H. pylori is unlikely to
grow in the environment, it has been found to survive for 3 weeks in biofilms and up
to 2030 days in surface waters. In a study conducted in the USA, H. pylori was found
in the majority of surface water and shallow groundwater samples. The presence of
H. pylori was not correlated with the presence of E. coli. Possible contamination of the
environment can be through children with diarrhoea or through vomiting by children
as well as adults.
Routes of exposure
Person-to-person contact within families has been identified as the most likely source
of infection through oraloral transmission. Helicobacter pylori can survive well in
mucus or vomit. However, it is difficult to detect in mouth or faecal samples. Faecal
oral transmission is also considered possible.
Significance in drinking-water
Consumption of contaminated drinking-water has been suggested as a potential source
of infection, but further investigation is required to establish any link with waterborne
transmission. Humans are the principal source of H. pylori, and the organism is sensitive to oxidizing disinfectants. Hence, control measures that can be applied to protect
drinking-water supplies from H. pylori include preventing contamination by human
waste and adequate disinfection. Escherichia coli (or, alternatively, thermotolerant coliforms) is not a reliable indicator for the presence/absence of this organism.
Selected bibliography
Dunn BE, Cohen H, Blaser MJ (1997) Helicobacter pylori. Clinical Microbiology Reviews, 10:
720741.
Hegarty JP, Dowd MT, Baker KH (1999) Occurrence of Helicobacter pylori in surface water in
the United States. Journal of Applied Microbiology, 87:697701.
Hulten K et al. (1996) Helicobacter pylori in drinking-water in Peru. Gastroenterology, 110:
10311035.
Mazari-Hiriart M, Lpez-Vidal Y, Calva JJ (2001) Helicobacter pylori in water systems for human
use in Mexico City. Water Science and Technology, 43:9398.
Klebsiella
General description
Klebsiella spp. are Gram-negative, non-motile bacilli that belong to the family Enterobacteriaceae. The genus Klebsiella consists of a number of species, including K. pneumoniae, K. oxytoca, K. planticola and K. terrigena. The outermost layer of Klebsiella
242
spp. consists of a large polysaccharide capsule that distinguishes the organisms from
other members of the family. Approximately 6080% of all Klebsiella spp. isolated from
faeces and clinical specimens are K. pneumoniae and are positive in the thermotolerant coliform test. Klebsiella oxytoca has also been identified as a pathogen.
Human health effects
Klebsiella spp. have been identified as colonizing hospital patients, where spread is associated with the frequent handling of patients (e.g. in intensive-care units). Patients
at highest risk are those with impaired immune systems, such as the elderly or very
young, patients with burns or excessive wounds, those undergoing immunosuppressive therapy or those with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection. Colonization may lead to invasive infections.
On rare occasions, Klebsiella spp., notably K. pneumoniae and K. oxytoca, may cause
serious infections, such as destructive pneumonia.
Source and occurrence
Klebsiella spp. are natural inhabitants of many water environments, and they may
multiply to high numbers in waters rich in nutrients, such as pulp mill wastes, textile
finishing plants and sugar-cane processing operations. In drinking-water distribution
systems, they are known to colonize washers in taps. The organisms can grow in water
distribution systems. Klebsiella spp. are also excreted in the faeces of many healthy
humans and animals, and they are readily detected in sewage-polluted water.
Routes of exposure
Klebsiella can cause nosocomial infections, and contaminated water and aerosols may
be a potential source of the organisms in hospital environments and other health-care
facilities.
Significance in drinking-water
Klebsiella spp. are not considered to represent a source of gastrointestinal illness in
the general population through ingestion of drinking-water. Klebsiella spp. detected
in drinking-water are generally biofilm organisms and are unlikely to represent a
health risk. The organisms are reasonably sensitive to disinfectants, and entry into
distribution systems can be prevented by adequate treatment. Growth within distribution systems can be minimized by strategies that are designed to minimize biofilm growth, including treatment to optimize organic carbon removal, restriction of
the residence time of water in distribution systems and maintenance of disinfectant
residuals. Klebsiella is a coliform and can be detected by traditional tests for total
coliforms.
Selected bibliography
Ainsworth R, ed. (2004) Safe piped water: Managing microbial water quality in piped distribution
systems. IWA Publishing, London, for the World Health Organization, Geneva.
Bartram J et al., eds (2003) Heterotrophic plate counts and drinking-water safety: The significance
of HPCs for water quality and human health. London, IWA Publishing (WHO Emerging
Issues in Water and Infectious Disease Series).
243
Legionella
General description
The genus Legionella, a member of the family Legionellaceae, has at least 50 species
comprising 70 distinct serogroups. Legionellae are Gram-negative, rod-shaped, nonspore-forming bacteria that require L-cysteine for growth and primary isolation.
Legionella spp. are heterotrophic bacteria found in a wide range of water environments and can proliferate at temperatures above 25 C.
Human health effects
Although all Legionella spp. are considered potentially pathogenic for humans, L.
pneumophila is the major waterborne pathogen responsible for legionellosis, of which
two clinical forms are known: Legionnaires disease and Pontiac fever. The former is a
pneumonic illness with an incubation period of 36 days. Host factors influence the
likelihood of illness: males are more frequently affected than females, and most cases
occur in the 40- to 70-year age group. Risk factors include smoking, alcohol abuse,
cancer, diabetes, chronic respiratory or kidney disease and immunosuppression, as in
transplant recipients. Pontiac fever is a milder, self-limiting disease with a high attack
rate and an onset (5 hours to 3 days) and symptoms similar to those of influenza:
fever, headache, nausea, vomiting, aching muscles and coughing. Studies of seroprevalence of antibodies indicate that many infections are asymptomatic.
Source and occurrence
Legionella spp. are members of the natural flora of many freshwater environments,
such as rivers, streams and impoundments, where they occur in relatively low numbers. However, they thrive in certain human-made water environments, such as water
cooling devices (cooling towers and evaporative condensers) associated with airconditioning systems, hot water distribution systems and spas, which provide suitable
temperatures (2550 C) and conditions for their multiplication. Devices that support multiplication of Legionella have been associated with outbreaks of Legionnaires
disease. Legionella survive and grow in biofilms and sediments and are more easily
detected from swab samples than from flowing water. Legionellae can be ingested by
trophozoites of certain amoebae such as Acanthamoeba, Hartmanella and Naegleria,
which play an important role in their persistence in water environments.
Routes of exposure
The most common route of infection is the inhalation of aerosols containing the bacteria. Such aerosols can be generated by contaminated cooling towers, warm water
showers, humidifiers and spas. Aspiration has also been identified as a route of infection in some cases associated with contaminated water, food and ice. There is no
evidence of person-to-person transmission.
Significance in drinking-water
Legionella spp. are common waterborne organisms, and devices such as cooling towers, hot water systems and spas that utilize mains water have been associated with
outbreaks of infection. Owing to the prevalence of Legionella, the potential for ingress
244
into drinking-water systems should be considered as a possibility, and control measures should be employed to reduce the likelihood of survival and multiplication. Disinfection strategies designed to minimize biofilm growth and temperature control
can minimize the potential risk from Legionella spp. The organisms are sensitive to
disinfection. Monochloramine has been shown to be particularly effective, probably
due to its stability and greater effectiveness against biofilms. Water temperature is
an important element of control strategies. Wherever possible, water temperatures
should be kept outside the range of 2550 C and preferably 2050 C to prevent the
growth of the organism. In hot water systems, temperatures leaving heaters should
be above 60 C, and temperatures above 50C should be maintained throughout associated pipework. However, maintaining temperatures of hot water above 50 C may
represent a scalding risk in young children, the elderly and other vulnerable groups.
Where temperatures in hot or cold water distribution systems cannot be maintained
outside the range of 2550 C, greater attention to disinfection and strategies aimed
at limiting development of biofilms are required. Accumulation of sludge, scale, rust,
algae or slime deposits in water distribution systems supports the growth of Legionella
spp., as does stagnant water. Systems that are kept clean and flowing are less likely to
support excess growth of Legionella spp. Care should also be taken to select plumbing
materials that do not support microbial growth and the development of biofilms.
Legionella spp. represent a particular concern in devices such as cooling towers
and hot water systems in large buildings. As discussed in chapter 6, specific water
safety plans incorporating control measures for Legionella spp. should be developed
for these buildings. Legionella are not detected by HPC techniques, and E. coli (or,
alternatively, thermotolerant coliforms) is not a suitable indicator for the presence/
absence of this organism.
Selected bibliography
Bartram J et al., eds (2007) Legionella and the prevention of legionellosis. Geneva, World Health
Organization.
Codony F et al. (2002) Factors promoting colonization by legionellae in residential water
distribution systems: An environmental casecontrol survey. European Journal of Clinical
Microbiology and Infectious Diseases, 21:717721.
Emmerson AM (2001) Emerging waterborne infections in health-care settings. Emerging
Infectious Diseases, 7:272276.
Rusin PA et al. (1997) Risk assessment of opportunistic bacterial pathogens in drinking-water.
Reviews of Environmental Contamination and Toxicology, 152:5783.
Leptospira
General description
Leptospires are aerobic spirochetes that are typically 0.1 m in diameter and 525 m
in length. There are two genera: Leptospira, which includes the pathogenic L. interrogans, and Leptonoma. Leptospira interrogans causes the important zoonotic and widespread disease leptospirosis. Pathogenic leptospires are maintained in host animals but,
depending on conditions, can survive for days to weeks in water. More than 200 pathogenic serovars have been identified, and these have been divided into 25 serogroups
based on serologic relatedness.
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with recreational exposure to water contaminated with urine from infected animals.
Outbreaks have also been associated with natural disasters involving flooding.
Significance in drinking-water
Waterborne leptospirosis is normally caused by contact with contaminated surface
water. Leptospires are sensitive to disinfectants; within a water safety plan, control
measures that should provide effective protection against this organism include application of standard disinfection processes for drinking-water together with protection
of distribution systems from contamination associated with flooding events. Because
leptospires are excreted in urine and persist in favourable environments, E. coli (or,
alternatively, thermotolerant coliforms) is not a suitable indicator for the presence/
absence of this organism.
Selected bibliography
Bharti AR et al. (2003) Leptospirosis: A zoonotic disease of global importance. Lancet Infectious
Diseases, 3:757771.
Pond K (2005) Water recreation and disease. Plausibility of associated infections: Acute effects,
sequelae and mortality. IWA Publishing, London, for the World Health Organization.
WHO (2003) Human leptospirosis: Guidance for diagnosis, surveillance and control. Geneva,
World Health Organization.
Mycobacterium
General description
The tuberculous or typical species of Mycobacterium, such as M. tuberculosis, M.
bovis, M. africanum and M. leprae, have only human or animal reservoirs and are not
transmitted by water. In contrast, the non-tuberculous or atypical species of Mycobacterium are natural inhabitants of a variety of water environments. These aerobic,
rod-shaped and acid-fast bacteria grow slowly in suitable water environments and
on culture media. Typical examples include the species M. gordonae, M. kansasii, M.
marinum, M. scrofulaceum, M. xenopi, M. intracellulare and M. avium and the more
rapid growers M. chelonae and M. fortuitum. The term M. avium complex has been
used to describe a group of pathogenic species including M. avium and M. intracellulare. However, other atypical mycobacteria are also pathogenic. A distinct feature of all
Mycobacterium spp. is a cell wall with high lipid content, which is used in identification of the organisms using acid-fast staining.
Human health effects
Atypical Mycobacterium spp. can cause a range of diseases involving the skeleton,
lymph nodes, skin and soft tissues, as well as the respiratory, gastrointestinal and genitourinary tracts. Manifestations include pulmonary disease, Buruli ulcer, osteomyelitis and septic arthritis in people with no known predisposing factors. These bacteria
are a major cause of disseminated infections in immunocompromised patients and
are a common cause of death in HIV-positive persons.
Source and occurrence
Atypical Mycobacterium spp. multiply in a variety of suitable water environments,
notably biofilms. One of the most commonly occurring species is M. gordonae. Other
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species have also been isolated from water, including M. avium, M. intracellulare,
M. kansasii, M. fortuitum and M. chelonae. High numbers of atypical Mycobacterium
spp. may occur in distribution systems after events that dislodge biofilms, such as
flushing or flow reversals. They are relatively resistant to treatment and disinfection
and have been detected in well-operated and well-maintained drinking-water supplies
with HPC less than 500/ml and total chlorine residuals of up to 2.8 mg/l. The growth
of these organisms in biofilms reduces the effectiveness of disinfection. In one survey, the organisms were detected in 54% of ice and 35% of public drinking-water
samples.
Routes of exposure
Principal routes of infection appear to be inhalation, contact and ingestion of contaminated water. Infections by various species have been associated with their presence in drinking-water supplies. In 1968, an endemic of M. kansasii infections was
associated with the presence of the organisms in the drinking-water supply, and the
spread of the organisms was associated with aerosols from showerheads. In Rotterdam, the Netherlands, an investigation into the frequent isolation of M. kansasii from
clinical specimens revealed the presence of the same strains, confirmed by phage type
and weak nitrase activity, in tap water. An increase in numbers of infections by the
M. avium complex in Massachusetts, USA, has also been attributed to their incidence
in drinking-water. In all these cases, there is only circumstantial evidence of a causal
relationship between the occurrence of the bacteria in drinking-water and human
disease. Infections have been linked to contaminated water in spas.
Significance in drinking-water
Detections of atypical mycobacteria in drinking-water and the identified routes of
transmission suggest that drinking-water supplies are a plausible source of infection.
There are limited data on the effectiveness of control measures that could be applied
to reduce the potential risk from these organisms. One study showed that a water
treatment plant could achieve a 99% reduction in numbers of mycobacteria from raw
water. Atypical mycobacteria are relatively resistant to disinfection. Persistent residual disinfectant should reduce numbers of mycobacteria in the water column but is
unlikely to be effective against organisms present in biofilms. Control measures that
are designed to minimize biofilm growth, including treatment to optimize organic
carbon removal, restriction of the residence time of water in distribution systems
and maintenance of disinfectant residuals, could result in less growth of these organisms. Mycobacteria are not detected by HPC techniques, and E. coli (or, alternatively,
thermotolerant coliforms) is not a suitable indicator for the presence/absence of this
organism.
Selected bibliography
Bartram J et al., eds (2003) Heterotrophic plate counts and drinking-water safety: The significance
of HPCs for water quality and human health. London, IWA Publishing (WHO Emerging
Issues in Water and Infectious Disease Series).
Bartram J et al., eds (2004) Pathogenic mycobacteria in water: A guide to public health consequences,
monitoring and management. Geneva, World Health Organization.
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Pseudomonas aeruginosa
General description
Pseudomonas aeruginosa is a member of the family Pseudomonadaceae and is a polarly flagellated, aerobic, Gram-negative rod. When grown in suitable media, it produces the non-fluorescent bluish pigment pyocyanin. Many strains also produce the
fluorescent green pigment pyoverdin. Pseudomonas aeruginosa, like other fluorescent
pseudomonads, produces catalase, oxidase and ammonia from arginine and can grow
on citrate as the sole source of carbon.
Human health effects
Pseudomonas aeruginosa can cause a range of infections but rarely causes serious illness in healthy individuals without some predisposing factor. It predominantly colonizes damaged sites such as burn and surgical wounds, the respiratory tract of people
with underlying disease and physically damaged eyes. From these sites, it may invade
the body, causing destructive lesions or septicaemia and meningitis. Cystic fibrosis
and immunocompromised patients are prone to colonization with P. aeruginosa,
which may lead to serious progressive pulmonary infections. Water-related folliculitis
and ear infections are associated with warm, moist environments such as swimming
pools and spas. Many strains are resistant to a range of antimicrobial agents, which can
increase the significance of the organism in hospital settings.
Source and occurrence
Pseudomonas aeruginosa is a common environmental organism and can be found in
faeces, soil, water and sewage. It can multiply in water environments and also on the
surface of suitable organic materials in contact with water. Pseudomonas aeruginosa is
a recognized cause of hospital-acquired infections with potentially serious complications. It has been isolated from a range of moist environments such as sinks, water
baths, hot water systems, showers and spa pools.
Routes of exposure
The main route of infection is by exposure of susceptible tissue, notably wounds and
mucous membranes, to contaminated water or contamination of surgical instruments.
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Cleaning of contact lenses with contaminated water can cause a form of keratitis. Ingestion of drinking-water is not an important source of infection.
Significance in drinking-water
Although P. aeruginosa can be significant in certain settings such as health-care
facilities, there is no evidence that normal uses of drinking-water supplies are a source
of infection in the general population. However, the presence of high numbers of
P. aeruginosa in potable water, notably in packaged water, can be associated with
complaints about taste, odour and turbidity. Pseudomonas aeruginosa is sensitive to
disinfection, and entry into distribution systems can be minimized by adequate disinfection. Control measures that are designed to minimize biofilm growth, including treatment to optimize organic carbon removal, restriction of the residence time
of water in distribution systems and maintenance of disinfectant residuals, should
reduce the growth of these organisms. Pseudomonas aeruginosa is detected by HPC,
which can be used together with parameters such as disinfectant residuals to indicate
conditions that could support growth of these organisms. However, as P. aeruginosa
is a common environmental organism, E. coli (or, alternatively, thermotolerant coliforms) cannot be used for this purpose.
Selected bibliography
Bartram J et al., eds (2003) Heterotrophic plate counts and drinking-water safety: The significance
of HPCs for water quality and human health. London, IWA Publishing (WHO Emerging
Issues in Water and Infectious Disease Series).
De Victorica J, Galvn M (2001) Pseudomonas aeruginosa as an indicator of health risk in water
for human consumption. Water Science and Technology, 43:4952.
Hardalo C, Edberg SC (1997) Pseudomonas aeruginosa: Assessment of risk from drinking-water.
Critical Reviews in Microbiology, 23:4775.
Salmonella
General description
Salmonella spp. belong to the family Enterobacteriaceae. They are motile, Gramnegative bacilli that do not ferment lactose, but most produce hydrogen sulfide or
gas from carbohydrate fermentation. Originally, they were grouped into more than
2000 species (serotypes) according to their somatic (O) and flagellar (H) antigens
(Kauffmann-White classification). There has been much debate about the nomenclature and taxonomy of Salmonella, but it is now considered that there are actually two
species (Salmonella enterica and Salmonella bongori). Other previously named species,
including S. Typhi and S. Paratyphi, are considered to be serovars.
Human health effects
Salmonella infections typically cause four clinical manifestations: gastroenteritis (ranging from mild to fulminant diarrhoea, nausea and vomiting), bacteraemia or septicaemia (high spiking fever with positive blood cultures), typhoid fever/enteric fever
(sustained fever with or without diarrhoea) and a carrier state in persons with previous infections. With regard to enteric illness, Salmonella spp. can be divided into two
fairly distinct groups: the typhoidal species/serovars (S. Typhi and S. Paratyphi) and
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the remaining non-typhoidal species/serovars. Symptoms of non-typhoidal gastroenteritis appear from 6 to 72 hours after ingestion of contaminated food or water.
Diarrhoea lasts 35 days and is accompanied by fever and abdominal pain. Usually the
disease is self-limiting. The incubation period for typhoid fever can be 114 days but is
usually 35 days. Typhoid fever is a more severe illness and can be fatal. Although typhoid is uncommon in areas with good sanitary systems, it is still prevalent elsewhere,
and there are many millions of cases each year.
Source and occurrence
Salmonella spp. are widely distributed in the environment, but some species or serovars show host specificity. Notably, S. Typhi and generally S. Paratyphi are restricted to
humans, although livestock can occasionally be a source of S. Paratyphi. A large number of serovars, including S. Typhimurium and S. Enteritidis, infect humans and also
a wide range of animals, including poultry, cows, pigs, sheep, birds and even reptiles.
The pathogens typically gain entry into water systems through faecal contamination
from sewage discharges, livestock and wild animals. Contamination has been detected
in a wide variety of foods and milk.
Routes of exposure
Salmonella is spread by the faecaloral route. Infections with non-typhoidal serovars
are primarily associated with person-to-person contact, the consumption of a variety
of contaminated foods and exposure to animals. Infection by typhoid species is associated with the consumption of contaminated water or food, with direct person-toperson spread being uncommon.
Significance in drinking-water
Waterborne typhoid fever outbreaks have devastating public health implications.
However, despite their widespread occurrence, non-typhoidal Salmonella spp. rarely cause drinking-water-borne outbreaks. Transmission, most commonly involving
S. Typhimurium, has been associated with the consumption of contaminated groundwater and surface water supplies. In an outbreak of illness associated with a communal
rainwater supply, bird faeces were implicated as a source of contamination. Salmonella
spp. are relatively sensitive to disinfection. Within a water safety plan, control measures that can be applied to manage risk include protection of raw water supplies from
human and animal waste, adequate treatment and protection of water during distribution. Escherichia coli (or, alternatively, thermotolerant coliforms) is a generally reliable indicator for Salmonella spp. in drinking-water supplies.
Selected bibliography
Angulo FJ et al. (1997) A community waterborne outbreak of salmonellosis and the effectiveness
of a boil water order. American Journal of Public Health, 87:580584.
Escartin EF et al. (2002) Potential Salmonella transmission from ornamental fountains. Journal
of Environmental Health, 65:912.
Koplan JP et al. (1978) Contaminated roof-collected rainwater as a possible cause of an outbreak
of salmonellosis. Journal of Hygiene, 81:303309.
Tindall BJ et al. (2005) Nomenclature and taxonomy of the genus Salmonella. International
Journal of Systematic and Evolutionary Microbiology, 5:521524.
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Shigella
General description
Shigella spp. are Gram-negative, non-spore-forming, non-motile, rod-like members
of the family Enterobacteriaceae, which grow in the presence or absence of oxygen.
Members of the genus have a complex antigenic pattern, and classification is based on
their somatic O antigens, many of which are shared with other enteric bacilli, including E. coli. There are four species: S. dysenteriae, S. flexneri, S. boydii and S. sonnei.
Human health effects
Shigella spp. can cause serious intestinal diseases, including bacillary dysentery. Over
2 million infections occur each year, resulting in about 600 000 deaths, predominantly
in developing countries. Most cases of Shigella infection occur in children under 10
years of age. The incubation period for shigellosis is usually 2472 hours. Ingestion
of as few as 10100 organisms may lead to infection, which is substantially less than
the infective dose of most other enteric bacteria. Abdominal cramps, fever and watery
diarrhoea occur early in the disease. All species can produce severe disease, but illness
due to S. sonnei is usually relatively mild and self-limiting. In the case of S. dysenteriae,
clinical manifestations may proceed to an ulceration process, with bloody diarrhoea
and high concentrations of neutrophils in the stool. The production of Shiga toxin by
the pathogen plays an important role in this outcome. Shigella spp. seem to be better
adapted to cause human disease than most other enteric bacterial pathogens.
Source and occurrence
Humans and other higher primates appear to be the only natural hosts for the shigellae. The bacteria remain localized in the intestinal epithelial cells of their hosts.
Epidemics of shigellosis occur in crowded communities and where hygiene is poor.
Many cases of shigellosis are associated with day-care centres, prisons and psychiatric
institutions. Military field groups and travellers to areas with poor sanitation are also
prone to infection.
Routes of exposure
Shigella spp. are enteric pathogens predominantly transmitted by the faecaloral route
through person-to-person contact, contaminated food and water. Flies have also been
identified as a transmission vector from contaminated faecal waste.
Significance in drinking-water
A number of large waterborne outbreaks of shigellosis have been recorded. As the organisms are not particularly stable in water environments, their presence in drinkingwater indicates recent human faecal pollution. Available data on prevalence in water
supplies may be an underestimate, because detection techniques generally used can
have a relatively low sensitivity and reliability. The control of Shigella spp. in drinkingwater supplies is of special public health importance in view of the severity of the disease caused. Shigella spp. are relatively sensitive to disinfection. Within a water safety
plan, control measures that can be applied to manage potential risk include protection
of raw water supplies from human waste, adequate treatment and protection of water
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Staphylococcus aureus
General description
Staphylococcus aureus is an aerobic or anaerobic, non-motile, non-spore-forming,
catalase- and coagulase-positive, Gram-positive coccus, usually arranged in grapelike
irregular clusters. The genus Staphylococcus contains at least 15 different species. Apart
from S. aureus, the species S. epidermidis and S. saprophyticus are also associated with
disease in humans.
Human health effects
Although Staphylococcus aureus is a common member of the human microflora, it
can produce disease through two different mechanisms. One is based on the ability
of the organisms to multiply and spread widely in tissues, and the other is based on
the ability of the organisms to produce extracellular enzymes and toxins. Infections
based on the multiplication of the organisms are a significant problem in hospitals
and other health-care facilities. Multiplication in tissues can result in manifestations
such as boils, skin sepsis, post-operative wound infections, enteric infections, septicaemia, endocarditis, osteomyelitis and pneumonia. The onset of clinical symptoms
for these infections is relatively long, usually several days. Gastrointestinal disease
(enterocolitis or food poisoning) is caused by a heat-stable staphylococcal enterotoxin
and characterized by projectile vomiting, diarrhoea, fever, abdominal cramps, electrolyte imbalance and loss of fluids. Onset of disease in this case has a characteristic short
incubation period of 18 hours. The same applies to the toxic shock syndrome caused
by toxic shock syndrome toxin-1.
Source and occurrence
Staphylococcus aureus is relatively widespread in the environment but is found mainly
on the skin and mucous membranes of animals. The organism is a member of the
normal microbial flora of the human skin and is found in the nasopharynx of 2030%
of adults at any one time. Staphylococci are occasionally detected in the gastrointestinal tract and can be detected in sewage. Staphylococcus aureus can be released by
human contact into water environments such as swimming pools, spa pools and other
recreational waters. It has also been detected in drinking-water supplies.
Routes of exposure
Hand contact is by far the most common route of transmission. Inadequate hygiene
can lead to contamination of food. Foods such as ham, poultry and potato and
egg salads kept at room or higher temperature offer an ideal environment for the
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multiplication of S. aureus and the release of toxins. The consumption of foods containing S. aureus toxins can lead to enterotoxin food poisoning within a few hours.
Significance in drinking-water
Although S. aureus can occur in drinking-water supplies, there is no evidence of transmission through the consumption of such water. Although staphylococci are slightly
more resistant to chlorine residuals than E. coli, their presence in water is readily
controlled by conventional treatment and disinfection processes. As faecal material
is not their usual source, E. coli (or, alternatively, thermotolerant coliforms) is not a
suitable indicator for S. aureus in drinking-water supplies.
Selected bibliography
Antai SP (1987) Incidence of Staphylococcus aureus, coliforms and antibiotic-resistant strains
of Escherichia coli in rural water supplies in Port Harcourt. Journal of Applied Bacteriology,
62:371375.
LeChevallier MW, Seidler RJ (1980) Staphylococcus aureus in rural drinking-water. Applied and
Environmental Microbiology, 39:739742.
Tsukamurella
General description
The genus Tsukamurella belongs to the family Nocardiaceae. Tsukamurella spp. are
Gram-positive, weakly or variably acid-fast, non-motile, obligate aerobic, irregular
rod-shaped bacteria. They are actinomycetes related to Rhodococcus, Nocardia and
Mycobacterium. The genus was created in 1988 to accommodate a group of chemically
unique organisms characterized by a series of very long chain (6876 carbons), highly
unsaturated mycolic acids, meso-diaminopimelic acid and arabinogalactan, common
to the genus Corynebacterium. The type species is T. paurometabola, and the following additional species were proposed in the 1990s: T. wratislaviensis, T. inchonensis,
T. pulmonis, T. tyrosinosolvens and T. strandjordae.
Human health effects
Tsukamurella spp. cause disease mainly in immunocompromised individuals. Infections with these microorganisms have been associated with chronic lung diseases,
immune suppression (leukaemia, tumours, HIV/AIDS infection) and post-operative
wound infections. Tsukamurella were reported in four cases of catheter-related bacteraemia and in individual cases including chronic lung infection, necrotizing tenosynovitis with subcutaneous abscesses, cutaneous and bone infections, meningitis and
peritonitis.
Source and occurrence
Tsukamurella spp. exist primarily as environmental saprophytes in soil, water and
foam (thick stable scum on aeration vessels and sedimentation tanks) of activated
sludge. Tsukamurella are represented in HPC populations in drinking-water.
Routes of exposure
Tsukamurella spp. appear to be transmitted through devices such as catheters or
lesions. The original source of the contaminating organisms is unknown.
254
Significance in drinking-water
Tsukamurella organisms have been detected in drinking-water supplies, but the significance is unclear. There is no evidence of a link between organisms in water and illness.
As Tsukamurella is an environmental organism, E. coli (or, alternatively, thermotolerant coliforms) is not a suitable indicator for this organism.
Selected bibliography
Bartram J et al., eds (2003) Heterotrophic plate counts and drinking-water safety: The significance
of HPCs for water quality and human health. London, IWA Publishing (WHO Emerging
Issues in Water and Infectious Disease Series).
Kattar MM et al. (2001) Tsukamurella strandjordae sp. nov., a proposed new species causing
sepsis. Journal of Clinical Microbiology, 39:14671476.
Larkin JA et al. (1999) Infection of a knee prosthesis with Tsukamurella species. Southern
Medical Journal, 92:831832.
Vibrio
General description
Vibrio spp. are small, curved (comma-shaped), Gram-negative bacteria with a single
polar flagellum. Species are typed according to their O antigens. There are a number of
pathogenic species, including V. cholerae, V. parahaemolyticus and V. vulnificus. Vibrio
cholerae is the only pathogenic species of significance from freshwater environments.
Although a number of serotypes can cause diarrhoea, only O1 and O139 currently
cause the classical cholera symptoms in which a proportion of cases suffer fulminating
and severe watery diarrhoea. The O1 serovar has been further divided into classical
and El Tor biotypes. The latter is distinguished by features such as the ability to produce a dialysable heat-labile haemolysin, active against sheep and goat red blood cells.
The classical biotype is considered responsible for the first six cholera pandemics,
whereas the El Tor biotype is responsible for the seventh pandemic that commenced
in 1961. Strains of V. cholerae O1 and O139 that cause cholera produce an enterotoxin
(cholera toxin) that alters the ionic fluxes across the intestinal mucosa, resulting in
substantial loss of water and electrolytes in liquid stools. Other factors associated with
infection are an adhesion factor and an attachment pilus. Not all strains of serotypes
O1 or O139 possess the virulence factors, and they are rarely possessed by non-O1/
O139 strains.
Human health effects
Cholera outbreaks continue to occur in many areas of the developing world. Symptoms
are caused by heat-labile cholera enterotoxin carried by toxigenic strains of V. cholerae
O1/O139. A large percentage of infected persons do not develop illness; about 60%
of the classical and 75% of the El Tor group infections are asymptomatic. Symptomatic illness ranges from mild or moderate to severe disease. The initial symptoms of
cholera are an increase in peristalses followed by loose, watery and mucus-flecked
rice-water stools that may cause a patient to lose as much as 1015 litres of liquid
per day. Decreasing gastric acidity by administration of sodium bicarbonate reduces
the infective dose of V. cholerae O1 from more than 108 to about 104 organisms. Case
255
fatality rates vary according to facilities and preparedness. As many as 60% of untreated patients may die as a result of severe dehydration and loss of electrolytes, but
well-established diarrhoeal disease control programmes can reduce fatalities to less
than 1%. Non-toxigenic strains of V. cholerae can cause self-limiting gastroenteritis,
wound infections and bacteraemia.
Source and occurrence
Non-toxigenic V. cholerae is widely distributed in water environments, but toxigenic
strains are not distributed as widely. Humans are an established source of toxigenic
V. cholerae; in the presence of disease, the organism can be detected in sewage. Although
V. cholerae O1 can be isolated from water in areas without disease, the strains are not
generally toxigenic. Toxigenic V. cholerae has also been found in association with live
copepods as well as other aquatic organisms, including molluscs, crustaceans, plants,
algae and cyanobacteria. Numbers associated with these aquatic organisms are often
higher than in the water. Non-toxigenic V. cholerae has been isolated from birds and
herbivores in areas far away from marine and coastal waters. The prevalence of V. cholerae decreases as water temperatures fall below 20 C.
Routes of exposure
Cholera is typically transmitted by the faecaloral route, and the infection is predominantly contracted by the ingestion of faecally contaminated water and food. The
high numbers required to cause infection make person-to-person contact an unlikely
route of transmission.
Significance in drinking-water
Contamination of water due to poor sanitation is largely responsible for transmission, but this does not fully explain the seasonality of recurrence, and factors other
than poor sanitation must play a role. The presence of the pathogenic V. cholerae O1
and O139 serotypes in drinking-water supplies is of major public health importance
and can have serious health and economic implications in the affected communities.
Vibrio cholerae is highly sensitive to disinfection processes. Within a water safety plan,
control measures that can be applied to manage potential risk from toxigenic V. cholerae include protection of raw water supplies from human waste, adequate treatment
and protection of water during distribution. Vibrio cholerae O1 and non-O1 have been
detected in the absence of E. coli, and this organism (or, alternatively, thermotolerant
coliforms) is not a reliable indicator for V. cholerae in drinking-water.
Selected bibliography
Kaper JB, Morris JG, Levine MM (1995) Cholera. Clinical Microbiology Reviews, 8:4886.
Ogg JE, Ryder RA, Smith HL (1989) Isolation of Vibrio cholerae from aquatic birds in Colorado
and Utah. Applied and Environmental Microbiology, 55:9599.
Rhodes JB, Schweitzer D, Ogg JE (1985) Isolation of non-O1 Vibrio cholerae associated with
enteric disease of herbivores in western Colorado. Journal of Clinical Microbiology, 22:572
575.
WHO (2002) Vibrio cholerae. In: Guidelines for drinking-water quality, 2nd ed. Addendum:
Microbiological agents in drinking water. Geneva, World Health Organization, pp. 119142.
256
Yersinia
General description
The genus Yersinia is classified in the family Enterobacteriaceae and comprises
seven species. The species Y. pestis, Y. pseudotuberculosis and certain serotypes of
Y. enterocolitica are pathogens for humans. Yersinia pestis is the cause of bubonic
plague through contact with rodents and their fleas. Yersinia spp. are Gram-negative
rods that are motile at 25 C but not at 37 C.
Human health effects
Yersinia enterocolitica penetrates cells of the intestinal mucosa, causing ulcerations of
the terminal ilium. Yersiniosis generally presents as an acute gastroenteritis with diarrhoea, fever and abdominal pain. Other clinical manifestations include greatly enlarged painful lymph nodes referred to as buboes. The disease seems to be more
acute in children than in adults.
Source and occurrence
Domestic and wild animals are the principal reservoir for Yersinia spp.; pigs are the
major reservoir of pathogenic Y. enterocolitica, whereas rodents and small animals are
the major reservoir of Y. pseudotuberculosis. Pathogenic Y. enterocolitica has been detected in sewage and polluted surface waters. However, Y. enterocolitica strains detected
in drinking-water are more commonly non-pathogenic strains of probable environmental origin. At least some species and strains of Yersinia seem to be able to replicate
in water environments if at least trace amounts of organic nitrogen are present, even
at temperatures as low as 4 C.
Routes of exposure
Yersinia spp. are transmitted by the faecaloral route, with the major source of infection considered to be foods, particularly meat and meat products, milk and dairy
products. Ingestion of contaminated water is also a potential source of infection. Direct transmission from person to person and from animals to humans is also known
to occur.
Significance in drinking-water
Although most Yersinia spp. detected in water are probably non-pathogenic, circumstantial evidence has been presented to support transmission of Y. enterocolitica
and Y. pseudotuberculosis to humans from untreated drinking-water. The most likely
source of pathogenic Yersinia spp. is human or animal waste. The organisms are sensitive to disinfection processes. Within a water safety plan, control measures that can be
used to minimize the presence of pathogenic Yersinia spp. in drinking-water supplies
include protection of raw water supplies from human and animal waste, adequate disinfection and protection of water during distribution. Owing to the long survival and/
or growth of some strains of Yersinia spp. in water, E. coli (or, alternatively, thermotolerant coliforms) is not a suitable indicator for the presence/absence of these organisms
in drinking-water.
257
Selected bibliography
Aleksic S, Bockemuhl J (1988) Serological and biochemical characteristics of 416 Yersinia strains
from well water and drinking water plants in the Federal Republic of Germany: Lack of
evidence that these strains are of public health significance. Zentralblatt fr Bakteriologie,
Mikrobiologie und Hygiene B, 185:527533.
Inoue M et al. (1988) Three outbreaks of Yersinia pseudotuberculosis infection. Zentralblatt fr
Bakteriologie, Mikrobiologie und Hygiene B, 186:504511.
Ostroff SM et al. (1994) Sources of sporadic Yersinia enterocolitica infections in Norway: A
prospective case control study. Epidemiology and Infection, 112:133141.
Waage AS et al. (1999) Detection of low numbers of pathogenic Yersinia enterocolitica in
environmental water and sewage samples by nested polymerase chain reaction. Journal of
Applied Microbiology, 87:814821.
considered important because they are exceptionally resistant to some water treatment and disinfection processes, notably ultraviolet (UV) light irradiation. Human
adenoviruses have been detected in drinking-water supplies that met accepted specifications for treatment, disinfection and conventional indicator organisms. Within a
water safety plan, control measures to reduce potential risk from human adenoviruses
should focus on prevention of source water contamination by human waste, followed
by adequate treatment and disinfection. The effectiveness of treatment processes
used to remove human adenoviruses will require validation. Drinking-water supplies
should also be protected from contamination during distribution. Because of the high
resistance of the viruses to disinfection, E. coli (or, alternatively, thermotolerant coliforms) is not a reliable indicator of the presence/absence of human adenoviruses in
drinking-water supplies.
Selected bibliography
Chapron CD et al. (2000) Detection of astroviruses, enteroviruses and adenoviruses types 40
and 41 in surface waters collected and evaluated by the information collection rule and
integrated cell culturenested PCR procedure. Applied and Environmental Microbiology,
66:25202525.
DAngelo LJ et al. (1979) Pharyngoconjunctival fever caused by adenovirus type 4: Report of
a swimming poolrelated outbreak with recovery of virus from pool water. Journal of
Infectious Diseases, 140:4247.
Grabow WOK, Taylor MB, de Villiers JC (2001) New methods for the detection of viruses: Call
for review of drinking water quality guidelines. Water Science and Technology, 43:18.
Puig M et al. (1994) Detection of adenoviruses and enteroviruses in polluted water by nested
PCR amplification. Applied and Environmental Microbiology, 60:29632970.
Astroviruses
General description
Human and animal strains of astroviruses are single-stranded ribonucleic acid (RNA)
viruses classified in the family Astroviridae. Astroviruses consist of a single-stranded
RNA genome in a non-enveloped icosahedral capsid with a diameter of about 28 nm.
In a proportion of the particles, a distinct surface star-shaped structure can be seen
by electron microscopy. Eight different serotypes of human astroviruses have been
described. The most commonly identified is human astrovirus serotype 1. Human
astroviruses can be detected in environmental samples using PCR techniques with or
without initial cell culture amplification.
Human health effects
Human astroviruses cause gastroenteritis, predominantly diarrhoea, mainly in children under 5 years of age, although it has also been reported in adults. Seroprevalence
studies showed that more than 80% of children between 5 and 10 years of age have
antibodies against human astroviruses. Occasional outbreaks in schools, nurseries and
families have been reported. The illness is self-limiting, is of short duration and has a
peak incidence in the winter. Human astroviruses are the cause of only a small proportion of reported gastroenteritis infections. However, the number of infections may be
underestimated, as the illness is usually mild, and many cases will go unreported.
260
Caliciviruses
General description
The family Caliciviridae consists of four genera of single-stranded RNA viruses with
a non-enveloped capsid (diameter 3540 nm), which generally displays a typical surface morphology resembling cup-like structures. Human caliciviruses include the
genera Norovirus (Norwalk-like viruses) and Sapovirus (Sapporo-like viruses). Sapovirus spp. demonstrate the typical calicivirus morphology and are called classical
caliciviruses. Noroviruses generally fail to reveal the typical morphology and were in
the past referred to as small round-structured viruses. The remaining two genera of
the family contain viruses that infect animals other than humans. Human caliciviruses
cannot be propagated in available cell culture systems. The viruses were originally
261
discovered by electron microscopy. Some Norovirus spp. can be detected by enzymelinked immunosorbent assay using antibodies raised against baculovirus-expressed
Norovirus capsid proteins. Several reverse transcriptase PCR procedures have been
described for the detection of human caliciviruses.
Human health effects
Human caliciviruses are a major cause of acute viral gastroenteritis in all age groups.
Symptoms include nausea, vomiting and abdominal cramps. Usually about 40% of
infected individuals present with diarrhoea; some have fever, chills, headache and muscular pain. As some cases present with vomiting only and no diarrhoea, the condition
is also known as winter vomiting disease. Infections by human caliciviruses induce a
short-lived immunity. The symptoms are usually relatively mild and rarely last for more
than 3 days. High attack rates in outbreaks indicate that the infecting dose is low.
Source and occurrence
Human caliciviruses are excreted in faeces of infected individuals and will therefore
be present in domestic wastewaters as well as faecally contaminated food and water,
including drinking-water supplies.
Routes of exposure
The epidemiology of the disease indicates that person-to-person contact and the inhalation of contaminated aerosols and dust particles, as well as airborne particles of
vomitus, are the most common routes of transmission. Drinking-water and a wide
variety of foods contaminated with human faeces have been confirmed as major
sources of exposure. Numerous outbreaks have been associated with contaminated
drinking-water, ice, water on cruise ships and recreational waters. Shellfish harvested
from sewage-contaminated waters have also been identified as a source of outbreaks.
Significance in drinking-water
Many human calicivirus outbreaks have been epidemiologically linked to contaminated drinking-water supplies. Within a water safety plan, control measures to reduce
potential risk from human caliciviruses should focus on prevention of source water
contamination by human waste, followed by adequate treatment and disinfection. The
effectiveness of treatment processes used to remove human caliciviruses will require
validation. Drinking-water supplies should also be protected from contamination during distribution. Owing to the higher resistance of the viruses to disinfection, E. coli
(or, alternatively, thermotolerant coliforms) is not a reliable indicator of the presence/
absence of human caliciviruses in drinking-water supplies.
Selected bibliography
Berke T et al. (1997) Phylogenetic analysis of the Caliciviridae. Journal of Medical Virology,
52:419424.
Jiang X et al. (1999) Design and evaluation of a primer pair that detects both Norwalk- and
Sapporo-like caliciviruses by RT-PCR. Journal of Virological Methods, 83:145154.
Mauer AM, Sturchler DA (2000) A waterborne outbreak of small round-structured virus,
Campylobacter and Shigella co-infections in La Neuveville, Switzerland, 1998. Epidemiology
and Infection, 125:325332.
262
Monroe SS, Ando T, Glass R (2000) Introduction: Human enteric calicivirusesAn emerging
pathogen whose time has come. Journal of Infectious Diseases, 181(Suppl. 2):S249251.
Enteroviruses
General description
The genus Enterovirus is a member of the family Picornaviridae. This genus consists of
69 serotypes (species) that infect humans: poliovirus types 13, coxsackievirus types
A1A24, coxsackievirus types B1B6, echovirus types 133 and the numbered enterovirus types EV68EV73. Members of the genus are collectively referred to as enteroviruses. Other species of the genus infect animals other than humansfor instance,
the bovine group of enteroviruses. Enteroviruses are among the smallest known
viruses and consist of a single-stranded RNA genome in a non-enveloped icosahedral
capsid with a diameter of 2030 nm. Some members of the genus, notably poliovirus,
coxsackievirus B, echovirus and enterovirus, are readily isolated by cytopathogenic
effect in cell cultures.
Human health effects
Enteroviruses are one of the most common causes of human infections. They have
been estimated to cause about 30 million infections in the USA each year. The
spectrum of diseases caused by enteroviruses is broad and ranges from a mild febrile
illness to myocarditis, meningoencephalitis, poliomyelitis, herpangina, hand-footand-mouth disease and neonatal multi-organ failure. The persistence of the viruses in
chronic conditions such as polymyositis, dilated cardiomyopathy and chronic fatigue
syndrome has been described. Most infections, particularly in children, are asymptomatic, but still lead to the excretion of large numbers of the viruses, which may
cause clinical disease in other individuals.
Source and occurrence
Enteroviruses are excreted in the faeces of infected individuals. Among the types of
viruses detectable by conventional cell culture isolation, enteroviruses are generally
the most numerous in sewage, water resources and treated drinking-water supplies.
The viruses are also readily detected in many foods.
Routes of exposure
Person-to-person contact and inhalation of airborne viruses or viruses in respiratory
droplets are considered to be the predominant routes of transmission of enteroviruses
in communities. Transmission from drinking-water could also be important, but this
has not yet been confirmed. Waterborne transmission of enteroviruses (coxsackievirus A16 and B5) has been epidemiologically confirmed for only two outbreaks, and
these were associated with children bathing in lake water in the 1970s.
Significance in drinking-water
Enteroviruses have been shown to occur in substantial numbers in raw water sources
and treated drinking-water supplies. In view of their prevalence, drinking-water represents a likely, although unconfirmed, source of enterovirus infection. The limited
263
Hepatitis A virus
General description
Hepatitis A virus (HAV) is the only species of the genus Hepatovirus in the family Picornaviridae. The virus shares basic structural and morphological features with other
members of the family, as described for enteroviruses. Human and simian HAVs are
genotypically distinguishable. HAV cannot be readily detected or cultivated in conventional cell culture systems, and identification in environmental samples is based
on the use of PCR techniques.
Human health effects
HAV is highly infectious, and the infecting dose is considered to be low. The virus
causes the disease hepatitis A, commonly known as infectious hepatitis. Like other
members of the group enteric viruses, HAV enters the gastrointestinal tract by ingestion, where it infects epithelial cells. From here, the virus enters the bloodstream and
reaches the liver, where it may cause severe damage to liver cells. In as many as 90%
of cases, particularly in children, there is little, if any, liver damage, and the infection passes without clinical symptoms and elicits lifelong immunity. In general, the
severity of illness increases with age. The damage to liver cells results in the release of
liver-specific enzymes such as aspartate aminotransferase, which are detectable in the
bloodstream and used as a diagnostic tool. The damage also results in the failure of the
liver to remove bilirubin from the bloodstream; the accumulation of bilirubin causes
the typical symptoms of jaundice and dark urine. After a relatively long incubation
period of 2830 days on average, there is a characteristic sudden onset of illness, including symptoms such as fever, malaise, nausea, anorexia, abdominal discomfort and
eventually jaundice. Although mortality is generally less than 1%, repair of the liver
264
damage is a slow process that may keep patients incapacitated for 6 weeks or longer.
This has substantial burden of disease implications. Mortality is higher in those over
50 years of age.
Source and occurrence
HAV occurs worldwide, but the prevalence of clinical disease has typical geographically based characteristics. HAV is excreted in faecal material of infected people, and
there is strong epidemiological evidence that faecally contaminated food and water
are common sources of the virus. In areas with poor sanitation, children are often
infected at a very early age and become immune for life without clinical symptoms of
disease. In areas with good sanitation, infection tends to occur later in life.
Routes of exposure
Person-to-person spread is probably the most common route of transmission, but
contaminated food and water are important sources of infection. There is stronger
epidemiological evidence for waterborne transmission of HAV than for any other
virus. Foodborne outbreaks are also relatively common, with sources of infection
including infected food handlers, shellfish harvested from contaminated water and
contaminated produce. Travel of people from areas with good sanitation to those with
poor sanitation provides a high risk of infection. Infection can also be spread in association with injecting and non-injecting drug use.
Significance in drinking-water
The transmission of HAV by drinking-water supplies is well established, and the presence of HAV in drinking-water constitutes a substantial health risk. Within a water
safety plan, control measures to reduce potential risk from HAV should focus on prevention of source water contamination by human waste, followed by adequate treatment and disinfection. The effectiveness of treatment processes used to remove HAV
will require validation. Drinking-water supplies should also be protected from contamination during distribution. Owing to the higher resistance of the viruses to disinfection, E. coli (or, alternatively, thermotolerant coliforms) is not a reliable indicator
of the presence/absence of HAV in drinking-water supplies.
Selected bibliography
Cuthbert JA (2001) Hepatitis A: Old and new. Clinical Microbiology Reviews, 14:3858.
WHO (2002) Enteric hepatitis viruses. In: Guidelines for drinking-water quality, 2nd ed.
Addendum: Microbiological agents in drinking water. Geneva, World Health Organization,
pp. 1839.
Hepatitis E virus
General description
Hepatitis E virus (HEV) consists of a single-stranded RNA genome in a non-enveloped
icosahedral capsid with a diameter of 2734 nm. HEV shares properties with a number of viruses, and classification is a challenge. At one stage, HEV was classified as a
member of the family Caliciviridae, but most recently it has been placed in a separate family called hepatitis Elike viruses. There are indications of antigenic variation,
265
and possibly even differences in serotypes of the virus, whereas human HAV consists
of only one clearly defined serotype. HEV cannot be readily detected or cultivated
in conventional cell culture systems, and identification in environmental samples is
based on the use of PCR techniques.
Human health effects
HEV causes hepatitis that is in many respects similar to that caused by HAV. However,
the incubation period tends to be longer (average 40 days), and infections typically
have a mortality rate of up to 25% in pregnant women. In endemic regions, first infections are typically seen in young adults rather than young children. Despite evidence
of antigenic variation, single infection appears to provide lifelong immunity to HEV.
Global prevalence has a characteristic geographic distribution. HEV is endemic and
causes clinical diseases in certain developing parts of the world, such as India, Nepal,
central Asia, Mexico and parts of Africa. In many of these areas, HEV is the most
important cause of viral hepatitis. Although seroprevalence can be high, clinical cases
and outbreaks are rare in certain parts of the world, such as Japan, South Africa, the
United Kingdom, North and South America, Australasia and central Europe. The reason for the lack of clinical cases in the presence of the virus is unknown.
Source and occurrence
HEV is excreted in faeces of infected people, and the virus has been detected in raw
and treated sewage. Contaminated water has been associated with very large outbreaks. HEV is distinctive, in that it is the only enteric virus with a meaningful animal
reservoir, including domestic animals, particularly pigs, as well as cattle, goats and
even rodents.
Routes of exposure
Secondary transmission of HEV from cases to contacts and particularly nursing staff
has been reported, but appears to be much less common than for HAV. The lower level
of person-to-person spread suggests that faecally polluted water could play a much
more important role in the spread of HEV than of HAV. Waterborne outbreaks involving thousands of cases are on record. These include one outbreak in 1954 with approximately 40 000 cases in Delhi, India; one with more than 100 000 cases in 19861988
in the Xinjiang Uighar region of China; and one in 1991 with some 79 000 cases in
Kanpur, India. Animal reservoirs may also serve as a route of exposure, but the extent
to which humans contract HEV infection from animals remains to be elucidated.
Significance in drinking-water
The role of contaminated water as a source of HEV has been confirmed, and the
presence of the virus in drinking-water constitutes a major health risk. There is no
laboratory information on the resistance of the virus to disinfection processes, but
data on waterborne outbreaks suggest that HEV may be as resistant as other enteric
viruses. Within a water safety plan, control measures to reduce potential risk from
HEV should focus on prevention of source water contamination by human and animal waste, followed by adequate treatment and disinfection. The effectiveness of treatment processes used to remove HEV will require validation. Drinking-water supplies
266
should also be protected from contamination during distribution. Owing to the likelihood that the virus has a higher resistance to disinfection, E. coli (or, alternatively,
thermotolerant coliforms) is not a reliable indicator of the presence/absence of HEV
in drinking-water supplies.
Selected bibliography
Pina S et al. (1998) Characterization of a strain of infectious hepatitis E virus isolated from
sewage in an area where hepatitis E is not endemic. Applied and Environmental Microbiology,
64:44854488.
Van der Poel WHM et al. (2001) Hepatitis E virus sequence in swine related to sequences in
humans, the Netherlands. Emerging Infectious Diseases, 7:970976.
WHO (2002) Enteric hepatitis viruses. In: Guidelines for drinking-water quality, 2nd ed.
Addendum: Microbiological agents in drinking water. Geneva, World Health Organization,
pp. 1839.
polluted with the human faeces are likely to contain large numbers of human rotaviruses. The viruses have been detected in sewage, rivers, lakes and treated drinkingwater. Orthoreoviruses generally occur in wastewater in substantial numbers.
Routes of exposure
Human rotaviruses are transmitted by the faecaloral route. Person-to-person transmission and the inhalation of airborne human rotaviruses or aerosols containing the
viruses would appear to play a much more important role than ingestion of contaminated food or water. This is confirmed by the spread of infections in childrens wards
in hospitals, which takes place much faster than can be accounted for by the ingestion
of food or water contaminated by the faeces of infected patients. The role of contaminated water in transmission is lower than expected, given the prevalence of human
rotavirus infections and presence in contaminated water. However, occasional waterborne and foodborne outbreaks have been described. Two large outbreaks in China in
19821983 were linked to contaminated water supplies.
Significance in drinking-water
Although ingestion of drinking-water is not the most common route of transmission, the presence of human rotaviruses in drinking-water constitutes a public health
risk. There is some evidence that the rotaviruses are more resistant to disinfection
than other enteric viruses. Within a water safety plan, control measures to reduce
potential risk from human rotaviruses should focus on prevention of source water
contamination by human waste, followed by adequate treatment and disinfection.
The effectiveness of treatment processes used to remove human rotaviruses will require validation. Drinking-water supplies should also be protected from contamination during distribution. Owing to a higher resistance of the viruses to disinfection,
E. coli (or, alternatively, thermotolerant coliforms) is not a reliable indicator of the
presence/absence of human rotaviruses in drinking-water supplies.
Selected bibliography
Baggi F, Peduzzi R (2000) Genotyping of rotaviruses in environmental water and stool samples
in southern Switzerland by nucleotide sequence analysis of 189 base pairs at the 5 end of
the VP7 gene. Journal of Clinical Microbiology, 38:36813685.
Gerba CP et al. (1996) Waterborne rotavirus: A risk assessment. Water Research, 30:29292940.
Hopkins RS et al. (1984) A community waterborne gastroenteritis outbreak: Evidence for
rotavirus as the agent. American Journal of Public Health, 74:263265.
Hung T et al. (1984) Waterborne outbreak of rotavirus diarrhoea in adults in China caused by
a novel rotavirus. Lancet, i:11391142.
Sattar SA, Raphael RA, Springthorpe VS (1984) Rotavirus survival in conventionally treated
drinking water. Canadian Journal of Microbiology, 30:653656.
generally used for the disinfection of water and in some cases can be difficult to remove
by filtration processes. Some of these organisms cause emerging diseases. In the last
30 years, the most notable example of an emerging disease caused by a protozoan
pathogen is cryptosporidiosis. Other examples are diseases caused by microsporidia
and Cyclospora. As evidence for waterborne transmission of emerging diseases has
been reported relatively recently, some questions about their epidemiology and behaviour in water treatment and disinfection processes remain to be elucidated. It would
appear that the role of water in the transmission of this group of pathogens may increase substantially in importance and complexity as human and animal populations
grow and the demands for potable drinking-water escalate.
Further information on emerging diseases is provided in Emerging issues in water
and infectious disease (WHO, 2003) and associated texts.
Acanthamoeba
General description
Acanthamoeba spp. are free-living amoebae (1050 m in diameter) common in aquatic environments and one of the prominent protozoa in soil. The genus contains some
20 species, of which A. castellanii, A. polyphaga and A. culbertsoni are known to be human pathogens. However, the taxonomy of the genus may change substantially when
evolving molecular biological knowledge is taken into consideration. Acanthamoeba
has a feeding, replicative trophozoite, which, under unfavourable conditions, such as
an anaerobic environment, will develop into a dormant cyst that can withstand extremes of temperature (20 C to 56 C), disinfection and desiccation.
Human health effects
Acanthamoeba culbertsoni causes granulomatous amoebic encephalitis, whereas A.
castellanii and A. polyphaga are associated with acanthamoebic keratitis and acanthamoebic uveitis.
Granulomatous amoebic encephalitis is a multifocal, haemorrhagic and necrotizing encephalitis that is generally seen only in debilitated or immunodeficient
persons. It is a rare, but usually fatal, disease. Early symptoms include drowsiness,
personality changes, intense headaches, stiff neck, nausea, vomiting, sporadic low
fevers, focal neurological changes, hemiparesis and seizures. This is followed by
an altered mental status, diplopia, paresis, lethargy, cerebellar ataxia and coma.
Death follows within a week to a year after the appearance of the first symptoms,
usually as a result of bronchopneumonia. Associated disorders of granulomatous
amoebic encephalitis include skin ulcers, liver disease, pneumonitis, renal failure
and pharyngitis.
Acanthamoebic keratitis is a painful infection of the cornea and can occur in
healthy individuals, especially among contact lens wearers. It is a rare disease that may
lead to impaired vision, permanent blindness and loss of the eye. The prevalence of
antibodies to Acanthamoeba and the detection of the organism in the upper airways of
healthy persons suggest that infection may be common with few apparent symptoms
in the vast majority of cases.
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Balantidium coli
General description
Balantidium coli is a unicellular protozoan parasite with a length up to 200 m, making it the largest of the human intestinal protozoa. The trophozoites are oval in shape
and covered with cilia for motility. The cysts are 6070 m in length and resistant to
unfavourable environmental conditions, such as pH and temperature extremes. Balantidium coli belongs to the largest protozoan group, the ciliates, with about 7200
species, of which only B. coli is known to infect humans.
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Blastocystis
General description
Blastocystis is a common anaerobic intestinal parasite that was first described in the
early 1900s. Despite this long history, there are large gaps in knowledge about the
organism, and the issue of pathogenicity remains a subject of some debate. Blastocystis spp. have been detected in a range of animal hosts, with isolates from humans
identified as Blastocystis hominis. However, molecular studies suggest that there is considerable antigenic and genetic heterogeneity within B. hominis and Blastocystis spp.
Blastocystis hominis lives in the colon and has several morphological forms, including
a faecal cyst that is believed to be the infective form.
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Cryptosporidium
General description
Cryptosporidium is an obligate, intracellular, coccidian parasite with a complex life
cycle including sexual and asexual replication. Thick-walled oocysts with a diameter
of 46 m are shed in faeces. The genus Cryptosporidium has about 13 species, with
human infections predominantly caused by C. hominis and the cattle genotype of
C. parvum. Other Cryptosporidium species have been reported to cause infrequent
infections. Cryptosporidium was discovered to infect humans in 1976, and waterborne
transmission was confirmed for the first time in 1984.
Human health effects
Cryptosporidium generally causes self-limiting diarrhoea, sometimes including nausea,
vomiting and fever, which usually resolves within a week in normally healthy people,
but can last for a month or more. Severity of cryptosporidiosis varies according to age
and immune status, and infections in severely immunocompromised people can be
life-threatening. The impact of cryptosporidiosis outbreaks is relatively high due to
the large numbers of people that may be involved and the associated socioeconomic
implications. The total cost of illness associated with the 1993 outbreak in Milwaukee,
USA, has been estimated at US$ 96.2 million.
Source and occurrence
A large range of animals are reservoirs of C. hominis/parvum, but humans and livestock, particularly young animals, are the most significant source of human infectious organisms. Calves can excrete 1010 oocysts per day. Concentrations of oocysts as
high as 14 000 per litre for raw sewage and 5800 per litre for surface water have been
reported. Oocysts can survive for weeks to months in fresh water. Cryptosporidium
oocysts have been detected in many drinking-water supplies. However, in most cases,
there is little information about whether human infectious species were present. The
currently available standard analytical techniques provide an indirect measure of
viability and no indication of human infectivity. Oocysts also occur in recreational
waters.
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Routes of exposure
Cryptosporidium is transmitted by the faecaloral route. The major route of infection is person-to-person contact. Other sources of infection include the consumption of contaminated food and water and direct contact with infected farm animals
and possibly domestic pets. Contaminated drinking-water, recreational water and, to
a lesser extent, food have been associated with outbreaks. In 1993, Cryptosporidium
caused the largest waterborne outbreak of disease on record, when more than 400 000
people were infected by the drinking-water supply of Milwaukee, USA. The infectivity
of Cryptosporidium oocysts is relatively high. Studies on healthy human volunteers
revealed that ingestion of fewer than 10 oocysts can lead to infection.
Significance in drinking-water
The role of drinking-water in the transmission of Cryptosporidium, including in large
outbreaks, is well established. Attention to these organisms is therefore important.
The oocysts are extremely resistant to oxidizing disinfectants such as chlorine, but
investigations based on assays for infectivity have shown that UV light irradiation
inactivates oocysts. Within a water safety plan, control measures to reduce potential
risk from Cryptosporidium should focus on prevention of source water contamination
by human and livestock waste, adequate treatment and protection of water during
distribution. Because of their relatively small size, the oocysts represent a challenge
for removal by conventional granular mediabased filtration processes. Acceptable
removal requires well-designed and well-operated systems. Membrane filtration processes that provide a direct physical barrier may represent a viable alternative for the
effective removal of Cryptosporidium oocysts. Owing to the exceptional resistance of
the oocysts to disinfectants, E. coli (or, alternatively, thermotolerant coliforms) cannot
be relied upon as an indicator for the presence/absence of Cryptosporidium oocysts in
drinking-water supplies.
Selected bibliography
Corso PS et al. (2003) Cost of illness in the 1993 waterborne Cryptosporidium outbreak,
Milwaukee, Wisconsin. Emerging Infectious Diseases, 9:426431.
Haas CN et al. (1996) Risk assessment of Cryptosporidium parvum oocysts in drinking water.
Journal of the American Water Works Association, 88:131136.
Leav BA, Mackay M, Ward HD (2003) Cryptosporidium species: New insight and old challenges.
Clinical Infectious Diseases, 36:903908.
Linden KG, Shin G, Sobsey MD (2001) Comparative effectiveness of UV wavelengths for the
inactivation of Cryptosporidium parvum oocysts in water. Water Science and Technology,
43:171174.
Medema G et al. (2009) Risk assessment of Cryptosporidium in drinking water. Geneva, World
Health Organization (WHO/HSE/WSH/09.04).
Okhuysen PC et al. (1999) Virulence of three distinct Cryptosporidium parvum isolates for
healthy adults. Journal of Infectious Diseases, 180:12751281.
Cyclospora cayetanensis
General description
Cyclospora cayetanensis is a single-celled, obligate, intracellular, coccidian protozoan
parasite, which belongs to the family Eimeriidae. It produces thick-walled oocysts of
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810 m in diameter that are excreted in the faeces of infected individuals. Cyclospora
cayetanensis is considered an emerging waterborne pathogen.
Human health effects
Sporozoites are released from the oocysts when ingested and penetrate epithelial cells
in the small intestine of susceptible individuals. Clinical symptoms of cyclosporiasis
include watery diarrhoea, abdominal cramping, weight loss, anorexia, myalgia and
occasionally vomiting and/or fever. Relapsing illness often occurs.
Source and occurrence
Humans are the only host identified for this parasite. The unsporulated oocysts pass
into the external environment with faeces and undergo sporulation, which is complete
in 712 days, depending on environmental conditions. Only the sporulated oocysts
are infectious. Owing to the lack of a quantification technique, there is limited information on the prevalence of Cyclospora in water environments. However, Cyclospora
has been detected in sewage and water sources.
Routes of exposure
Cyclospora cayetanensis is transmitted by the faecaloral route. Person-to-person
transmission is virtually impossible, because the oocysts must sporulate outside the
host to become infectious. The primary routes of exposure are contaminated water
and food. The initial source of organisms in foodborne outbreaks has generally not
been established, but consumption of food crops irrigated with contaminated water
has been implicated in several cases. Drinking-water has also been implicated as a
cause of outbreaks. The first report was among staff of a hospital in Chicago, USA, in
1990. The infections were associated with drinking tap water that had possibly been
contaminated with stagnant water from a rooftop storage reservoir. Another outbreak
was reported from Nepal, where drinking-water consisting of a mixture of river and
municipal water was associated with infections in 12 of 14 soldiers.
Significance in drinking-water
Transmission of the pathogens by drinking-water has been confirmed. The oocysts
are resistant to disinfection and are not inactivated by chlorination practices generally applied in the production of drinking-water. Within a water safety plan, control measures that can be applied to manage potential risk from Cyclospora include
prevention of source water contamination by human waste, followed by adequate
treatment and protection of water during distribution. Owing to the resistance of
the cysts to disinfectants, E. coli (or, alternatively, thermotolerant coliforms) cannot
be relied upon as an indicator of the presence/absence of Cyclospora in drinkingwater supplies.
Selected bibliography
Curry A, Smith HV (1998) Emerging pathogens: Isospora, Cyclospora and microsporidia.
Parasitology, 117:S143159.
Dowd SE et al. (2003) Confirmed detection of Cyclospora cayetanensis, Encephalitozoon
intestinalis and Cryptosporidium parvum in water used for drinking. Journal of Water and
Health, 1:117123.
275
Entamoeba histolytica
General description
Entamoeba histolytica is the most prevalent intestinal protozoan pathogen worldwide
and belongs to the superclass Rhizopoda in the subphylum Sarcodina. Entamoeba has
a feeding, replicative trophozoite (diameter 1060 m), which, under unfavourable
conditions, will develop into a dormant cyst (diameter 1020 m). Infection is contracted by the ingestion of cysts. Recent studies with RNA and DNA probes demonstrated genetic differences between pathogenic and non-pathogenic E. histolytica; the
latter has been separated and reclassified as E. dispar.
Human health effects
About 8595% of human infections with E. histolytica are asymptomatic. Acute intestinal amoebiasis has an incubation period of 114 weeks. Clinical disease results
from the penetration of the epithelial cells in the gastrointestinal tract by the amoebic
trophozoites. Approximately 10% of infected individuals present with dysentery or
colitis. Symptoms of amoebic dysentery include diarrhoea with cramping, lower abdominal pain, low-grade fever and the presence of blood and mucus in the stool. The
ulcers produced by the invasion of the trophozoites may deepen into the classic flaskshaped ulcers of amoebic colitis. Entamoeba histolytica may invade other parts of the
body, such as the liver, lungs and brain, sometimes with fatal outcome.
Source and occurrence
Humans are the reservoir of infection, and there would not appear to be other meaningful animal reservoirs of E. histolytica. In the acute phase of infection, patients
excrete only trophozoites that are not infectious. Chronic cases and asymptomatic
carriers who excrete cysts are more important sources of infection and can discharge up to 1.5 107 cysts daily. Entamoeba histolytica can be present in sewage
and contaminated water. Cysts may remain viable in suitable aquatic environments
for several months at low temperature. The potential for waterborne transmission
is greater in the tropics, where the carrier rate sometimes exceeds 50%, compared
with more temperate regions, where the prevalence in the general population may
be less than 10%.
Routes of exposure
Person-to-person contact and contamination of food by infected food handlers appear to be the most significant means of transmission, although contaminated water
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also plays a substantial role. Ingestion of faecally contaminated water and consumption of food crops irrigated with contaminated water can both lead to transmission
of amoebiasis. Sexual transmission, particularly among male homosexuals, has also
been documented.
Significance in drinking-water
The transmission of E. histolytica by contaminated drinking-water has been confirmed. The cysts are relatively resistant to disinfection and may not be inactivated by
chlorination practices generally applied in the production of drinking-water. Within a
water safety plan, control measures that can be applied to manage potential risk from
E. histolytica include prevention of source water contamination by human waste, followed by adequate treatment and protection of water during distribution. Owing to
the resistance of the cysts to disinfectants, E. coli (or, alternatively, thermotolerant coliforms) cannot be relied upon as an indicator of the presence/absence of E. histolytica
in drinking-water supplies.
Selected bibliography
Marshall MM et al. (1997) Waterborne protozoan pathogens. Clinical Microbiology Reviews,
10:6785.
Giardia intestinalis
General description
Giardia spp. are flagellated protozoa that parasitize the gastrointestinal tract of humans
and certain animals. The genus Giardia consists of a number of species, but human
infection (giardiasis) is usually assigned to G. intestinalis, also known as G. lamblia
or G. duodenalis. Giardia has a relatively simple life cycle consisting of a flagellate
trophozoite that multiplies in the gastrointestinal tract and an infective thick-walled
cyst that is shed intermittently but in large numbers in faeces. The trophozoites are
bilaterally symmetrical and ellipsoidal in shape. The cysts are ovoid in shape and 812
m in diameter.
Human health effects
Giardia has been known as a human parasite for 200 years. After ingestion and excystation of cysts, the trophozoites attach to surfaces of the gastrointestinal tract. Infections
in both children and adults may be asymptomatic. In day-care centres, as many as 20%
of children may carry Giardia and excrete cysts without clinical symptoms. The symptoms of giardiasis may result from damage caused by the trophozoites, although the
mechanisms by which Giardia causes diarrhoea and intestinal malabsorption remain
controversial. Symptoms generally include diarrhoea and abdominal cramps; in severe cases, however, malabsorption deficiencies in the small intestine may be present,
mostly among young children. Giardiasis is self-limiting in most cases, but it may be
chronic in some patients, lasting more than 1 year, even in otherwise healthy people.
Studies on human volunteers revealed that fewer than 10 cysts constitute a meaningful
risk of infection.
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Isospora belli
General description
Isospora is a coccidian, single-celled, obligate parasite related to Cryptosporidium and
Cyclospora. There are many species of Isospora that infect animals, but only I. belli is
known to infect humans, the only known host for this species. Isospora belli is one
of the few coccidia that undergo sexual reproduction in the human intestine. Sporulated oocysts are ingested, and, after complete asexual and sexual life cycles in the
mucosal epithelium of the upper small intestine, unsporulated oocysts are released
in faeces.
Human health effects
Illness caused by I. belli is similar to that caused by Cryptosporidium and Giardia.
About 1 week after ingestion of viable oocysts, a low-grade fever, lassitude and malaise
may appear, followed soon by mild diarrhoea and vague abdominal pain. The infection is usually self-limited after 12 weeks, but occasionally diarrhoea, weight loss and
fever may last for 6 weeks to 6 months. Symptomatic isosporiasis is more common
in children than in adults. Infection is often associated with immunocompromised
patients, in whom symptoms are more severe and likely to be recurrent or chronic,
leading to malabsorption and weight loss. Infections are usually sporadic and most
common in the tropics and subtropics, although they also occur elsewhere, including
industrialized countries. They have been reported from Central and South America,
Africa and south-east Asia.
Source and occurrence
Unsporulated oocysts are excreted in the faeces of infected individuals. The oocysts
sporulate within 12 days in the environment to produce the potentially infectious
form of the organism. Few data are available on numbers of oocysts in sewage and raw
and treated water sources. This is largely because sensitive and reliable techniques for
the quantitative enumeration of oocysts in water environments are not available. Little
is known about the survival of oocysts in water and related environments.
Routes of exposure
Poor sanitation and faecally contaminated food and water are the most likely sources
of infection, but waterborne transmission has not been confirmed. The oocysts are
less likely than Cryptosporidium oocysts or Giardia cysts to be transmitted directly
from person to person, because freshly shed I. belli oocysts require 12 days in the
environment to sporulate before they are capable of infecting humans.
Significance in drinking-water
The characteristics of I. belli suggest that illness could be transmitted by contaminated drinking-water supplies, but this has not been confirmed. No information is
available on the effectiveness of water treatment processes for removal of I. belli, but
it is likely that the organism is relatively resistant to disinfectants. It is considerably
larger than Cryptosporidium and should be easier to remove by filtration. Within a
water safety plan, control measures that can be applied to manage potential risk from
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Microsporidia
General description
Microsporidia are eukaryotic obligate intracellular parasites belonging to the phylum Microspora. Although microsporidia were initially considered to be protozoa, the scientific classification is uncertain, with recent studies indicating that they
could be classified as fungi. More than 100 microsporidial genera and almost 1000
species have been identified. Infections occur in every major animal group, including
vertebrates and invertebrates. A number of genera have been implicated in human
infections, including Enterocytozoon, Encephalitozoon (including Septata), Nosema,
Pleistophora, Vittaforma and Trachipleistophora, as well as a collective group of unclassified microsporidia referred to as microsporidium. Microsporidia are among the
smallest eukaryotes. They produce unicellular spores with a diameter of 1.04.5 m
and a characteristic coiled polar filament for injecting the sporoplasm into a host cell
to initiate infection. Within an infected cell, a complex process of multiplication takes
place, and new spores are produced and released in faeces, urine, respiratory secretions or other body fluids, depending on the type of species and the site of infection.
Human health effects
Microsporidia are emerging human pathogens identified predominantly in persons
with AIDS, but their ability to cause disease in immunologically normal hosts has
been recognized. Reported human infections are globally dispersed and have been
documented in persons from all continents. The most common clinical manifestation
in AIDS patients is a severe enteritis involving chronic diarrhoea, dehydration and
weight loss. Prolonged illness for up to 48 months has been reported. Infections in the
general population are less pronounced. Enterocytozoon infection generally appears to
be limited to intestinal enterocytes and biliary epithelium. Encephalitozoon spp. infect
a variety of cells, including epithelial and endothelial cells, fibroblasts, kidney tubule
cells, macrophages and possibly other cell types. Unusual complications include keratoconjunctivitis, myositis and hepatitis.
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Joynson DHM (1999) Emerging parasitic infections in man. The Infectious Disease Review,
1:131134.
Slifko TR, Smith HV, Rose JB (2000) Emerging parasite zoonoses associated with water and
food. International Journal for Parasitology, 30:13791393.
Naegleria fowleri
General description
Naegleria are free-living amoeboflagellates distributed widely in the environment.
There are several species of Naegleria, of which N. fowleri is the primary infectious
species. Naegleria spp. exist as a trophozoite, a flagellate and a cyst stage. The trophozoite (1020 m) moves by eruptive pseudopod formation, feeding on bacteria, and
reproduces by binary fission. The trophozoite can transform into a flagellate stage
with two anterior flagella. The flagellate does not divide but reverts to the trophozoite
stage. Under adverse conditions, the trophozoite transforms into a circular cyst (715
m), which is resistant to unfavourable conditions.
Human health effects
Naegleria fowleri causes primary amoebic meningoencephalitis in healthy individuals.
The amoeba enters the brain by penetrating the olfactory mucosa and cribiform plate.
The disease is acute, and patients often die within 510 days and before the infectious
agent can be diagnosed. Treatment is difficult. Although the infection is rare, new
cases are reported every year.
Source and occurrence
Naegleria fowleri is thermophilic and grows well at temperatures up to 45 C. It occurs naturally in fresh water of suitable temperature, and prevalence is only indirectly
related to human activity, inasmuch as such activity may modify temperature or promote bacterial (food source) production. The pathogen has been reported from many
countries, usually associated with thermally polluted water environments such as geothermal water or heated swimming pools. However, the organism has been detected in
drinking-water supplies, particularly where water temperature can exceed 2530 C.
Water is the only known source of infection. The first cases of amoebic meningitis
were diagnosed in 1965 in Australia and Florida. Since that time, about 100 cases of
primary amoebic meningoencephalitis have been reported throughout the world.
Routes of exposure
Infection with N. fowleri is almost exclusively contracted by exposure of the nasal passages to contaminated water. Infection is predominantly associated with recreational
use of water, including swimming pools and spas, as well as surface waters naturally heated by the sun, industrial cooling waters and geothermal springs. In a limited
number of cases, a link to recreational water exposure is lacking. The occurrence of
primary amoebic meningoencephalitis is highest during hot summer months, when
many people engage in water recreation and when the temperature of water is conducive to growth of the organism. Consumption of contaminated water or food and
person-to-person spread have not been reported as routes of transmission.
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Significance in drinking-water
Naegleria fowleri has been detected in drinking-water supplies. Although unproven, a
direct or indirect role of drinking-water-derived organismsfor example, through use
of drinking-water in swimming poolsis possible. Any water supply that seasonally
exceeds 30 C or that continually exceeds 25 C can potentially support the growth of
N. fowleri. In such cases, a periodic prospective study would be valuable. Free chlorine
or monochloramine residuals in excess of 0.5 mg/l have been shown to control N. fowleri, providing the disinfectant persists through the water distribution system. In addition to maintaining persistent disinfectant residuals, other control measures aimed at
limiting the presence of biofilm organisms will reduce food sources and hence growth
of the organism in distribution systems. Owing to the environmental nature of this
amoeba, E. coli (or, alternatively, thermotolerant coliforms) cannot be relied upon as
an indicator for the presence/absence of N. fowleri in drinking-water supplies.
Selected bibliography
Behets J et al. (2003) Detection of Naegleria spp. and Naegleria fowleri: a comparison of
flagellation tests, ELISA and PCR. Water Science and Technology, 47:117122.
Cabanes P-A et al. (2001) Assessing the risk of primary amoebic meningoencephalitis from
swimming in the presence of environmental Naegleria fowleri. Applied and Environmental
Microbiology, 67:29272931.
Dorsch MM, Cameron AS, Robinson BS (1983) The epidemiology and control of primary
amoebic meningoencephalitis with particular reference to South Australia. Transactions of
the Royal Society of Tropical Medicine and Hygiene, 77:372377.
Martinez AJ, Visvesvara GS (1997) Free-living amphizoic and opportunistic amebas. Brain
Pathology, 7:583598.
Parija SC, Jayakeerthee SR (1999) Naegleria fowleri: a free living amoeba of emerging medical
importance. Communicable Diseases, 31:153159.
Toxoplasma gondii
General description
Toxoplasma gondii is a coccidian parasite, and the cat is the definitive host. Felid animals harbour the parasite in the intestinal tract, where sexual reproduction takes place.
The actively multiplying asexual form in the human host is an obligate, intracellular
parasite (diameter 36 m) called a tachyzoite. A chronic phase of the disease develops
as the tachyzoites transform into slowly replicating bradyzoites, which eventually become cysts in the host tissue. In the natural cycle, mice and rats containing infective
cysts are eaten by cats, which host the sexual stage of the parasite. The cyst wall is
digested, and bradyzoites penetrate epithelial cells of the small intestine. Several generations of intracellular multiplication lead to the development of microgametes and
macrogametes. Fertilization of the latter leads to the development of oocysts that are
excreted in faeces as early as 5 days after a cat has ingested the cysts. Oocysts require
15 days to sporulate in the environment. Sporulated oocysts and tissue-borne cysts
can both cause infections in susceptible hosts.
Human health effects
Toxoplasmosis is usually asymptomatic in humans. In a small percentage of cases, flulike symptoms, lymphadenopathy and hepatosplenomegaly present 523 days after
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the ingestion of cysts or oocysts. Dormant cysts, formed in organ tissue after primary
infection, can be reactivated when the immune system becomes suppressed, producing
disseminated disease involving the central nervous system and lungs and leading to
severe neurological disorders or pneumonia. When these infection sites are involved,
the disease can be fatal in immunocompromised patients. Congenital toxoplasmosis is
mostly asymptomatic, but can produce chorioretinitis, cerebral calcifications, hydrocephalus, severe thrombocytopenia and convulsions. Primary infection during early
pregnancy can lead to spontaneous abortion, stillbirth or fetal abnormality.
Source and occurrence
Toxoplasmosis is found worldwide. Estimates indicate that in many parts of the world,
1530% of lamb and pork meat is infected with cysts. The prevalence of oocyst-shedding
cats may be 1%. By the third decade of life, about 50% of the European population
is infected, and in France this proportion is close to 80%. Toxoplasma gondii oocysts
may occur in water sources and supplies contaminated with the faeces of infected cats.
Owing to a lack of practical methods for the detection of T. gondii oocysts, there is
little information on the prevalence of the oocysts in raw and treated water supplies.
Details on the survival and behaviour of the oocysts in water environments are also not
available. However, qualitative evidence of the presence of oocysts in faecally polluted
water has been reported, and results suggest that T. gondii oocysts may be as resistant to
unfavourable conditions in water environments as the oocysts of related parasites.
Routes of exposure
Both T. gondii oocysts that sporulate after excretion by cats and tissue-borne cysts are
potentially infectious. Humans can become infected by ingestion of oocysts excreted
by cats by direct contact or through contact with contaminated soil or water. Two
outbreaks of toxoplasmosis have been associated with consumption of contaminated
water. In Panama, creek water contaminated by oocysts from jungle cats was identified as the most likely source of infection, whereas in 1995, an outbreak in Canada
was associated with a drinking-water reservoir being contaminated by excreta from
domestic or wild cats. A study in Brazil during 19971999 identified the consumption
of unfiltered drinking-water as a risk factor for T. gondii seropositivity. More commonly, humans contract toxoplasmosis through the consumption of undercooked or
raw meat and meat products containing T. gondii cysts. Transplacental infection also
occurs.
Significance in drinking-water
Contaminated drinking-water has been identified as a source of toxoplasmosis outbreaks. Little is known about the response of T. gondii to water treatment processes.
The oocysts are larger than Cryptosporidium oocysts and should be amenable to removal by filtration. Within a water safety plan, control measures to manage potential
risk from T. gondii should be focused on prevention of source water contamination
by wild and domesticated cats. If necessary, the organisms can be removed by filtration. Owing to the lack of information on sensitivity of T. gondii to disinfection, the
reliability of E. coli (or, alternatively, thermotolerant coliforms) as an indicator for the
presence/absence of these organisms in drinking-water supplies is unknown.
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Selected bibliography
Aramini JJ et al. (1999) Potential contamination of drinking water with Toxoplasma gondii
oocysts. Epidemiology and Infection, 122:305315.
Bahia-Oliveira LMG et al. (2003) Highly endemic, waterborne toxoplasmosis in North Rio de
Janeiro State, Brazil. Emerging Infectious Diseases, 9:5562.
Bowie WR et al. (1997) Outbreak of toxoplasmosis associated with municipal drinking water.
The BC Toxoplasma Investigation Team. Lancet, 350:173177.
Kourenti C et al. (2003) Development and application of different methods for the detection of
Toxoplasma gondii in water. Applied and Environmental Microbiology, 69:102106.
Selected bibliography
Cairncross S, Muller R, Zagaria N (2002) Dracunculiasis (guinea worm disease) and the
eradication initiative. Clinical Microbiology Reviews, 15:223246.
Hopkins DR, Ruiz-Tiben E (1991) Strategies for dracunculiasis eradication. Bulletin of the World
Health Organization, 69:533540.
Fasciola spp.
Fascioliasis is caused by two trematode species of the genus Fasciola: F. hepatica,
present in Europe, Africa, Asia, the Americas and Oceania, and F. gigantica, mainly
distributed in Africa and Asia. Human fascioliasis was considered a secondary zoonotic disease until the mid-1990s. In most regions, fascioliasis is a foodborne disease.
However, the discovery of floating metacercariae in hyperendemic regions (including
the Andean Altiplano region in South America) indicates that drinking-water may be
a significant transmission route for fascioliasis in certain locations.
General description
The life cycle of F. hepatica and F. gigantica takes about 1423 weeks and requires two
hosts. The life cycle comprises four phases. In the first phase, the definitive host ingests
metacercariae. The metacercariae excyst in the intestinal tract and then migrate to the
liver and bile ducts. After 34 months, the flukes attain sexual maturity and produce
eggs, which are excreted into the bile and intestine. Adult flukes can live for 914 years
in the host. In the second phase, the eggs are excreted by the human or animal. Once
in fresh water, a miracidium develops inside. In the third phase, miracidia penetrate
a snail host and develop into cercaria, which are released into the water. In the fourth
and final phase, cercariae swim for a short period of time until they reach a suitable attachment site (aquatic plants), where they encyst to form metacercariae, which
become infective within 24 hours. Some metacercariae do not attach to plants but
remain floating in the water.
Human health effects
The parasites inhabit the large biliary passages and the gall-bladder. Disease symptoms
are different for the acute and chronic phases of the infection. The invasive or acute
phase may last from 2 to 4 months and is characterized by symptoms such as dyspepsia, nausea and vomiting, abdominal pain and a high fever (up to 40 C). Anaemia
and allergic responses (e.g. pruritis, urticaria) may also occur. In children, the acute
infection can be accompanied by severe symptoms and sometimes causes death. The
obstructive or chronic phase (after months to years of infection) may be characterized
by painful liver enlargement and in some cases obstructive jaundice, chest pains, loss
of weight and cholelithiasis. The most important pathogenic sequelae are hepatic lesions and fibrosis and chronic inflammation of the bile ducts. Immature flukes may
deviate during migration, enter other organs and cause ectopic fascioliasis in a range
of subcutaneous tissues. Fascioliasis can be treated with triclabendazole.
Source and occurrence
Human cases have been increasing in 51 countries on five continents. Estimates of
the numbers of humans with fascioliasis range from 2.4 to 17 million people or even
higher, depending on unquantified prevalence in many African and Asian countries.
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Analysis of the geographical distribution of human cases shows that the correlation between human fascioliasis and fascioliasis in animals occurs only at a basic level.
High prevalences in humans are not necessarily related to areas where fascioliasis is a
great veterinary problem. Major health problems associated with fascioliasis occur in
Andean countries (the Plurinational State of Bolivia, Peru, Chile, Ecuador), the Caribbean (Cuba), northern Africa (Egypt), the Near East (the Islamic Republic of Iran and
neighbouring countries) and western Europe (Portugal, France and Spain).
Routes of exposure
Humans can contract fascioliasis when they ingest infective metacercariae by eating
raw aquatic plants (and, in some cases, terrestrial plants, such as lettuce, irrigated with
contaminated water), drinking contaminated water, using utensils washed in contaminated water or eating raw liver infected with immature flukes.
Significance in drinking-water
Water is often cited as a human infection source. In the Bolivian Altiplano, 13% of
metacercariae isolates are floating. Untreated drinking-water in hyperendemic regions
often contains floating metacercariae; for example, a small stream crossing in the Altiplano region of the Plurinational State of Bolivia contained up to 7 metacercariae per
500 ml. The importance of fascioliasis transmission through water is supported by
indirect evidence. There are significant positive associations between liver fluke infection and infection by other waterborne protozoans and helminths in Andean countries and in Egypt. In many human hyperendemic areas of the Americas, people do
not have a history of eating watercress or other water plants. In the Nile Delta region,
people living in houses with piped water had a higher infection risk. Metacercariae
are likely to be resistant to chlorine disinfection but should be removed by various
filtration processes. For example, in Tiba, Egypt, human prevalence was markedly decreased after filtered water was supplied to specially constructed washing units.
Selected bibliography
Mas-Coma S (2004) Human fascioliasis. In: Cotruvo JA et al., eds. Waterborne zoonoses:
Identification, causes, and controls. IWA Publishing, London, on behalf of the World Health
Organization, Geneva.
Mas-Coma S, Esteban JG, Bargues MD (1999) Epidemiology of human fascioliasis: A review and
proposed new classification. Bulletin of the World Health Organization, 77(4):340346.
WHO (1995) Control of foodborne trematode infections. Geneva, World Health Organization
(WHO Technical Report Series, No. 849).
Free-living nematodes
General description
Nematodes are the most numerous metazoan (many-celled) animals on Earth. Many
of them are parasites of insects, plants or animals, including humans. Free-living species are abundant in aquatic environments, both freshwater and saltwater, and soil
habitats. Not only are the vast majority of species encountered poorly understood
biologically, but there may be thousands more unknown species of nematodes yet
to be discovered. Nematodes are structurally simple, with the digestive tract run288
ning from the mouth on the anterior end to the posterior opening near the tail, being
characterized as a tube in a tube. Nematodes found in drinking-water systems range
in size from 0.1 mm to over 0.6 mm.
About 20 different orders have been distinguished within the phylum Nematoda.
Four of these orders (Rhabditida, Tylenchida, Aphelenchida and Dorylaimida) are particularly common in soil. Non-pathogenic free-living nematodes that have been found
in drinking-water include Cheilobus, Diplogaster, Tobrilus, Aphelenchus and Rhabditis.
Human health effects
The presence of free-living nematodes in drinking-water does not necessarily indicate a direct health threat. It has largely been regarded by water suppliers as an aesthetic problem, either directly or through their association with discoloured water.
High concentrations of nematodes in drinking-water have been reported to impart
an unpleasant taste to the drinking-water. The presence of free-living nematodes in
drinking-water reduces its acceptability to the consumer.
It has been suggested that free-living nematodes could carry pathogenic bacteria
in their gut. Such bacteria would be protected from chlorine disinfection and might
therefore present a health hazard. Enterobacteriaceae have been isolated from the
microflora in the guts of nematodes taken from a treated water supply and from the
raw water from which it was derived. However, they were of non-pathogenic genera.
Opportunistic pathogens such as Nocardia and Mycobacterium may also be carried
in the gut of the free-living nematodes. There is no reason to suppose that pathogens would be selectively favoured. The microorganisms present in the gut of the freeliving nematodes are much more likely to reflect those in the sediments and biofilms
where they are feeding.
In some cases, the motile larvae of parasitic nematodes such as hookworms
(Necator americanus and Ancylostoma duodenale) and threadworms (Strongyloides
stercoralis) are capable of moving themselves through sand filters or may be introduced into drinking-water during distribution as the result of faecal contamination.
There are also some other species of nematodes that theoretically could infect humans through ingestion of contaminated water. Such a source of infection, however,
is difficult to prove. Dracunculus medinensis is a noticeable parasitic nematode that
may occur in drinking-water. This parasite is reported elsewhere in this section.
Source and occurrence
Because free-living nematodes are ubiquitous, they, as an egg or free-living larval or
adult form, can enter the drinking-water supply at the storage, treatment, distribution or household level. The concentration of free-living nematodes in the raw water
source generally corresponds to the turbidity of the water. The higher the turbidity,
the larger the concentration of free-living nematodes there will be.
In warm or even temperate weather, slow sand filters may discharge nematodes
and Oligochaetes (e.g. Aeolosoma spp.), insect larvae (e.g. Chironomus spp.) and
mosquitoes (Culex spp.)by drawdown into the filtered water. Aquatic animals that
successfully penetrate drinking-water treatment processes are largely benthic species,
living on the bottoms or margins of water bodies.
289
Routes of exposure
Potential health concerns arise from exposure to the nematodes through ingestion
of drinking-water, during recreation and potentially through consumption of fresh
vegetables fertilized with sewage that received non-lethal treatment. Distinguishing
pathogenic larvae of the hookworm and threadworm from free-living non-pathogenic
nematodes in water is difficult and requires special knowledge of nematology.
Significance in drinking-water
Large numbers of nematodes are not normally found in well-maintained, piped
drinking-water systems. Eggs or infective larvae from species parasitic to humans (Ascaris, Trichuris, Ancylostoma, Necator and Strongyloides) and the many non-pathogenic
nematodes are not usually present in protected groundwater sources or are generally
removed during treatment processes.
In some circumstances, when the water contains a high nutrient or organic matter content and the ambient temperatures are appropriate, it may be possible for freeliving nematodes to feed on microbial growth in the biofilms or slimes in treatment
processes or in water mains and thus multiply within the system. This is particularly true
if drinking-water sources have not been adequately protected, treatment systems are not
adequate or not operated and maintained properly, the distribution system is leaking or
there are many stagnant areas or dead zones in the distribution system. Detection of
large numbers of nematodes (live and dead) in drinking-water indicates that there is a
problem that needs to be resolved, without necessarily implying a direct health risk.
Selected bibliography
Ainsworth R, ed. (2004) Safe piped water: Managing microbial water quality in piped distribution
systems. Geneva, World Health Organization.
Brusca RC, Brusca GJ (2002) Invertebrates, 2nd ed. Sunderland, MA, Sinauer Associates Inc.
Chang SL, Woodward RL, Kabler PW (1960) Survey of free-living nematodes and amebas in
municipal supplies. Journal of the American Water Works Association, 52:613.
Endo T, Morishima Y (2004) Major helminth zoonoses in water. In: Cotruvo JA et al., eds.
Waterborne zoonoses: Identification, causes, and controls. IWA Publishing, London, on
behalf of the World Health Organization, Geneva, pp. 291304.
Evins C, Greaves GF (1979) Penetration of water treatment works by animals. Medmenham,
Water Research Centre (Technical Report TR 115).
Lupi E, Ricci V, Burrini D (1995) Recovery of bacteria in nematodes from a drinking water
supply. Journal of Water Supply: Research and Technology Aqua, 44:212218.
McSorley R (2007) Soil-inhabiting nematodes, Phylum Nematoda. Gainesville, FL, University
of Florida, Institute of Food and Agricultural Sciences, Department of Entomology and
Nematology.
Mott JB, Mulamoottil G, Harrison AD (1981) A 13-month survey of nematodes at three water
treatment plants in southern Ontario, Canada. Water Research, 15:729.
Tombes AS et al. (1979) The relationship between rainfall and nematode density in drinking
water. Water Research, 13:619.
Schistosoma spp.
General description
The genus Schistosoma is a member of the class Trematoda, commonly known as
trematodes or blood flukes. The life cycle takes about 34 months and requires two
290
hosts. There are about 20 species of Schistosoma, and adult flukes are found in humans, other mammals and birds. Unlike other trematode species, Schistosoma has two
distinct sexual forms. In the most important human schistosomes, adult flukes are
1220 mm in length and 0.30.6 mm in width; male flukes are shorter and thicker
than the females. Adult worms of schistosomes reside in the mesenteric blood vessels
of the definitive host. Once the worms mature, they mate, and the females produce
eggs that are round or oval and vary in length from 50 to 200 m. Depending on the
infecting species, a large number of eggs released by the females reach either the intestine or the bladder and are excreted in faeces or urine, respectively. The eggs hatch in
fresh water, and the larvae (miracidia) invade snail hosts, where they undergo asexual
reproduction and develop into the infective larvae (cercariae). Cercariae have pearshaped heads and forked tails and are 400600 m in length. They emerge into the
water from snails and invade the final hosts, including humans.
Human health effects
Schistosomiasis, also known as bilharzia, is a group of infectious diseases caused by
five major species of Schistosoma in humans. Intestinal schistosomiasis is caused by
Schistosoma mansoni, S. japonicum, S. mekongi and S. intercalatum, whereas urinary schistosomiasis is caused by S. haematobium. Most of the symptoms of schistosomiasis are the manifestation of the bodys reaction to the eggs laid and are due
to the intensity of the immune response of the host, not to the worms themselves.
Therefore, the symptoms depend on the amount and location of eggs in the human host, and light infections can be asymptomatic. In some people, an initial allergic reaction (Katayama fever), including fever, chills, muscle pains and cough,
can begin within 12 months of infection immediately before and during initial egg
deposition. Chronic infections with S. mansoni, S. japonicum, S. intercalatum and S.
mekongi result primarily in intestinal and hepatic symptoms, including bloody diarrhoea (bilharzial dysentery), abdominal pains and hepatosplenomegaly, whereas S.
haematobium infection leads to urinary manifestation, including dysuria and haematuria. Important life-threatening complications that arise from chronic infections
include liver fibrosis and portal hypertension. Later development of bladder cancer
and renal failure is associated with urinary schistosomiasis. Rarely, eggs are found
in the brain or spinal cord and can cause cerebral symptoms, such as seizures and
paralysis. Anaemia and malnutrition are also found in young infected cases. Impaired
growth, impaired development and poor cognition are signs of morbidity in infected
school-age children. In total, more than 200 million people are infected in 75 countries. The number of deaths associated with schistosomiasis is estimated at 20 000
annually. Schistosomiasis is of great public health and socioeconomic importance in
developing countries where it is endemic.
Source and occurrence
Schistosomes occur in tropical and subtropical freshwater sources. Schistosoma mansoni is found in Africa, the Arabian Peninsula, Brazil, Suriname, the Bolivarian Republic of Venezuela and some Caribbean islands; S.haematobium is found in Africa
and the Middle East; S. japonicum is found in China, the Philippines and the Sulawesi
291
Cyanotoxins
Anabaena spp.
Aphanizomenon spp.
Cylindrospermum spp.
Lyngbya spp.
Microcystis spp.
Nodularia spp.
Nostoc spp.
Oscillatoria spp.
Planktothrix spp.
Raphidiopsis curvata
Umezakia natans
Nodularins
Microcystins
Anatoxin-a, microcystins
Anatoxin-a, homoanatoxin-a, microcystins
Cylindrospermopsins
Cylindrospermopsins
conditions, including sunlight, high nutrient levels, low turbulence and warm weather,
can promote growth. Depending on the species, this may result in greenish discoloration of water due to a high density of suspended cells and, in some cases, the formation
of surface scums. Such cell accumulations may lead to high toxin concentrations.
Routes of exposure
Potential health concerns arise from exposure to the toxins through ingestion of
drinking-water, during recreation, through showering and potentially through consumption of algal food supplement tablets. Repeated or chronic exposure is the primary concern for many of the cyanotoxins; in some cases, however, acute toxicity
is more important (e.g. lyngbyatoxins and the neurotoxins saxitoxin and anatoxin).
Human fatalities have occurred through use of inadequately treated water containing
high cyanotoxin levels for renal dialysis. Dermal exposure may lead to irritation of the
skin and mucous membranes and possibly also to allergic reactions.
Significance in drinking-water
Cyanobacteria occur in low cell density in most surface waters. However, under environmental conditions supporting their proliferation, high-density blooms can occur.
Eutrophication (increased biological growth associated with increased nutrients) can
support the development of cyanobacterial blooms. Control measures to reduce the
potential for blooms include catchment management to minimize nutrient inputs to
source waters, maintaining flow in regulated rivers and water mixing techniques, both to
eliminate stratification and to reduce nutrient release from sediments in reservoirs.
Selected bibliography
Backer LC (2002) Cyanobacterial harmful algal blooms (CyanoHABs): Developing a public
health response. Lake and Reservoir Management, 18:2031.
Chorus I, Bartram J, eds (1999) Toxic cyanobacteria in water: A guide to their public health
consequences, monitoring and management. Published by E & FN Spon, London, on behalf
of the World Health Organization, Geneva.
Lahti K et al. (2001) Occurrence of microcystins in raw water sources and treated drinking
water of Finnish waterworks. Water Science and Technology, 43:225228.
relatively high concentrations of bile salts with the fermentation of lactose and
production of acid or aldehyde within 24 hours at 3537 C. Escherichia coli and
thermotolerant coliforms are a subset of the total coliform group that can ferment
lactose at higher temperatures (see below). As part of lactose fermentation, total
coliforms produce the enzyme -galactosidase. Traditionally, coliform bacteria were
regarded as belonging to the genera Escherichia, Citrobacter, Klebsiella and Enterobacter, but the group is more heterogeneous and includes a wider range of genera, such
as Serratia and Hafnia. The total coliform group includes both faecal and environmental species.
Indicator value
Total coliforms include organisms that can survive and grow in water. Hence, they
are not useful as an indicator of faecal pathogens, but they can be used to assess the
cleanliness and integrity of distribution systems and the potential presence of biofilms.
However, there are better indicators for these purposes. It has been proposed that total
coliforms could be used as a disinfection indicator. However, the test for total coliforms
is far slower and less reliable than direct measurement of disinfectant residual. In addition, total coliforms are far more sensitive to disinfection than are enteric viruses and
protozoa. HPC measurements detect a wider range of microorganisms and are generally considered a better indicator of distribution system integrity and cleanliness.
Source and occurrence
Total coliform bacteria (excluding E. coli) occur in both sewage and natural waters.
Some of these bacteria are excreted in the faeces of humans and animals, but many
coliforms are heterotrophic and able to multiply in water and soil environments. Total
coliforms can also survive and grow in water distribution systems, particularly in the
presence of biofilms.
Application in practice
Total coliforms are generally measured in 100 ml samples of water. A variety of relatively simple procedures are available based on the production of acid from lactose
or the production of the enzyme -galactosidase. The procedures include membrane
filtration followed by incubation of the membranes on selective media at 3537 C
and counting of colonies after 24 hours. Alternative methods include most probable
number procedures using tubes or microtitre plates and presence/absence tests. Field
test kits are available.
Significance in drinking-water
Total coliforms should be absent immediately after disinfection, and the presence of
these organisms indicates inadequate treatment. The presence of total coliforms in distribution systems and stored water supplies can reveal regrowth and possible biofilm formation or contamination through ingress of foreign material, including soil or plants.
Selected bibliography
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality. In: Fewtrell
L, Bartram J, eds. Water qualityGuidelines, standards and health: Assessment of risk and
295
risk management for water-related infectious disease. London, IWA Publishing, pp. 289315
(WHO Water Series).
Grabow WOK (1996) Waterborne diseases: Update on water quality assessment and control.
Water SA, 22:193202.
Sueiro RA et al. (2001) Evaluation of Coli-ID and MUG Plus media for recovering Escherichia
coli and other coliform bacteria from groundwater samples. Water Science and Technology,
43:213216.
Significance in drinking-water
The presence of E. coli (or, alternatively, thermotolerant coliforms) provides evidence
of recent faecal contamination, and detection should lead to consideration of further
action, which could include further sampling and investigation of potential sources
such as inadequate treatment or breaches in distribution system integrity.
Selected bibliography
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality. In: Fewtrell
L, Bartram J, eds. Water qualityGuidelines, standards and health: Assessment of risk and
risk management for water-related infectious disease. London, IWA Publishing, pp. 289315
(WHO Water Series).
George I et al. (2001) Use of rapid enzymatic assays to study the distribution of faecal coliforms
in the Seine river (France). Water Science and Technology, 43:7780.
Grabow WOK (1996) Waterborne diseases: Update on water quality assessment and control.
Water SA, 22:193202.
Sueiro RA et al. (2001) Evaluation of Coli-ID and MUG Plus media for recovering Escherichia
coli and other coliform bacteria from groundwater samples. Water Science and Technology,
43:213216.
of pollution sources. They occur in large numbers in raw water sources. The actual
organisms detected by HPC tests vary widely between locations and between consecutive samples. Some drinking-water treatment processes, such as coagulation and
sedimentation, reduce the number of HPC organisms in water. However, the organisms proliferate in other treatment processes, such as biologically active carbon and
sand filtration. Numbers of HPC organisms are reduced significantly by disinfection practices, such as chlorination, ozonation and UV light irradiation. However,
in practice, none of the disinfection processes sterilizes water; under suitable conditions, such as the absence of disinfectant residuals, HPC organisms can grow rapidly.
HPC organisms can grow in water and on surfaces in contact with water as biofilms.
The principal determinants of growth or regrowth are temperature, availability
of nutrients, including assimilable organic carbon, lack of disinfectant residual and
stagnation.
Application in practice
No sophisticated laboratory facilities or highly trained staff are required. Results on
simple aerobically incubated agar plates are available within hours to days, depending
on the characteristics of the procedure used.
Significance in drinking-water
After disinfection, numbers would be expected to be low; for most uses of HPC
test results, however, actual numbers are of less value than changes in numbers at
particular locations. In distribution systems, increasing numbers can indicate a
deterioration in cleanliness, possibly stagnation and the potential development of
biofilms. HPC can include potentially opportunistic pathogens such as Acinetobacter, Aeromonas, Flavobacterium, Klebsiella, Moraxella, Serratia, Pseudomonas
and Xanthomonas. However, there is no evidence of an association of any of these
organisms with gastrointestinal infection through ingestion of drinking-water in the
general population.
Selected bibliography
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality. In: Fewtrell
L, Bartram J, eds. Water qualityGuidelines, standards and health: Assessment of risk and
risk management for water-related infectious disease. London, IWA Publishing, pp. 289315
(WHO Water Series).
Bartram J et al., eds (2003) Heterotrophic plate counts and drinking-water safety: The significance
of HPCs for water quality and human health. London, IWA Publishing (WHO Emerging
Issues in Water and Infectious Disease Series).
Intestinal enterococci
General description
Intestinal enterococci are a subgroup of the larger group of organisms defined as
faecal streptococci, comprising species of the genus Streptococcus. These bacteria are
Gram-positive and relatively tolerant of sodium chloride and alkaline pH levels. They
are facultatively anaerobic and occur singly, in pairs or as short chains. Faecal streptococci including intestinal enterococci all give a positive reaction with Lancefields
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Group D antisera and have been isolated from the faeces of warm-blooded animals.
The subgroup intestinal enterococci consists of the species Enterococcus faecalis,
E. faecium, E. durans and E. hirae. This group was separated from the rest of the faecal
streptococci because they are relatively specific for faecal pollution. However, some
intestinal enterococci isolated from water may occasionally also originate from other
habitats, including soil, in the absence of faecal pollution.
Indicator value
The intestinal enterococci group can be used as an indicator of faecal pollution. Most
species do not multiply in water environments. The numbers of intestinal enterococci
in human faeces are generally about an order of magnitude lower than those of E. coli.
Important advantages of this group are that they tend to survive longer in water environments than E. coli (or thermotolerant coliforms), are more resistant to drying
and are more resistant to chlorination. Intestinal enterococci have been used in testing
of raw water as an indicator of faecal pathogens that survive longer than E. coli and in
drinking-water to augment testing for E. coli. In addition, they have been used to test
water quality after repairs to distribution systems or after new mains have been laid.
Source and occurrence
Intestinal enterococci are typically excreted in the faeces of humans and other warmblooded animals. Some members of the group have also been detected in soil in the
absence of faecal contamination. Intestinal enterococci are present in large numbers
in sewage and water environments polluted by sewage or wastes from humans and
animals.
Application in practice
Enterococci are detectable by simple, inexpensive cultural methods that require basic
bacteriology laboratory facilities. Commonly used methods include membrane filtration with incubation of membranes on selective media and counting of colonies after
incubation at 3537 C for 48 hours. Other methods include a most probable number
technique using microtitre plates where detection is based on the ability of intestinal
enterococci to hydrolyse 4-methyl-umbelliferyl--D-glucoside in the presence of thallium acetate and nalidixic acid within 36 hours at 41 C.
Significance in drinking-water
The presence of intestinal enterococci provides evidence of recent faecal contamination, and detection should lead to consideration of further action, which could include
further sampling and investigation of potential sources such as inadequate treatment
or breaches in distribution system integrity.
Selected bibliography
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality. In: Fewtrell
L, Bartram J, eds. Water qualityGuidelines, standards and health: Assessment of risk and
risk management for water-related infectious disease. London, IWA Publishing, pp. 289315
(WHO Water Series).
Grabow WOK (1996) Waterborne diseases: Update on water quality assessment and control.
Water SA, 22:193202.
299
Junco TT et al. (2001) Identification and antibiotic resistance of faecal enterococci isolated from
water samples. International Journal of Hygiene and Environmental Health, 203:363368.
Pinto B et al. (1999) Characterization of faecal streptococci as indicators of faecal pollution
and distribution in the environment. Letters in Applied Microbiology, 29:258263.
Clostridium perfringens
General description
Clostridium spp. are Gram-positive, anaerobic, sulfite-reducing bacilli. They produce
spores that are exceptionally resistant to unfavourable conditions in water environments, including UV irradiation, temperature and pH extremes, and disinfection
processes, such as chlorination. The characteristic species of the genus, C. perfringens, is a member of the normal intestinal flora of 1335% of humans and other
warm-blooded animals. Other species are not exclusively of faecal origin. Like E. coli,
C. perfringens does not multiply in most water environments and is a highly specific
indicator of faecal pollution.
Indicator value
In view of the exceptional resistance of C. perfringens spores to disinfection processes
and other unfavourable environmental conditions, C. perfringens has been proposed as
an indicator of protozoa in treated drinking-water supplies. In addition, C. perfringens
can serve as an indicator of faecal pollution that took place previously and hence can
indicate sources liable to intermittent contamination. The evidence that Clostridium is
a reliable indicator for enteric viruses is limited and inconsistent, largely based on one
study of reductions by drinking-water treatment. Results should be treated with some
caution, as the exceptionally long survival times of its spores are likely to far exceed
those of enteric pathogens. Clostridium perfringens spores are smaller than protozoan
(oo)cysts and may be useful indicators of the effectiveness of filtration processes.
Source and occurrence
Clostridium perfringens and its spores are virtually always present in sewage. The organism does not multiply in water environments. Clostridium perfringens is present
more often and in higher numbers in the faeces of some animals, such as dogs, than
in the faeces of humans and less often in the faeces of many other warm-blooded
animals. The numbers excreted in faeces are normally substantially lower than those
of E. coli.
Application in practice
Vegetative cells and spores of C. perfringens are usually detected by membrane filtration techniques in which membranes are incubated on selective media under strict
anaerobic conditions. These detection techniques are not as simple and inexpensive as
those for other indicators, such as E. coli and intestinal enterococci.
Significance in drinking-water
The presence of C. perfringens in drinking-water can be an indicator of intermittent
faecal contamination. Potential sources of contamination should be investigated.
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Filtration processes designed to remove enteric viruses or protozoa should also remove C. perfringens. Detection in water immediately after treatment should lead to
investigation of filtration plant performance.
Selected bibliography
Araujo M et al. (2001) Evaluation of fluorogenic TSC agar for recovering Clostridium perfringens
in groundwater samples. Water Science and Technology, 43:201204.
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality. In: Fewtrell
L, Bartram J, eds. Water qualityGuidelines, standards and health: Assessment of risk and
risk management for water-related infectious disease. London, IWA Publishing, pp. 289315
(WHO Water Series).
Nieminski EC, Bellamy WD, Moss LR (2000) Using surrogates to improve plant performance.
Journal of the American Water Works Association, 92(3):6778.
Payment P, Franco E (1993) Clostridium perfringens and somatic coliphages as indicators of
the efficiency of drinking-water treatment for viruses and protozoan cysts. Applied and
Environmental Microbiology, 59:24182424.
Coliphages
General description
Bacteriophages (phages) are viruses that use only bacteria as hosts for replication.
Coliphages use E. coli and closely related species as hosts and hence can be released by
these bacterial hosts into the faeces of humans and other warm-blooded animals. Coliphages used in water quality assessment are divided into the major groups of somatic
coliphages and F-RNA coliphages. Differences between the two groups include the
route of infection.
Somatic coliphages initiate infection by attaching to receptors permanently located on the cell wall of hosts. They replicate more frequently in the gastrointestinal
tract of warm-blooded animals but can also replicate in water environments. Somatic
coliphages consist of a wide range of phages (members of the phage families Myoviridae, Siphoviridae, Podoviridae and Microviridae) with a spectrum of morphological types.
F-RNA coliphages initiate infection by attaching to fertility (F-, sex) fimbriae
on E. coli hosts. These F-fimbriae are produced only by bacteria carrying the fertility (F-) plasmid. As F-fimbriae are produced only in the logarithmic growth phase at
temperatures above 30 C, F-RNA phages are not likely to replicate in environments
other than the gastrointestinal tract of warm-blooded animals. F-RNA coliphages
comprise a restricted group of closely related phages, which belong to the family
Leviviridae, and consist of a single-stranded RNA genome and an icosahedral capsid
that is morphologically similar to that of picornaviruses. F-RNA coliphages have been
divided into serological types IIV, which can be identified as genotypes by molecular
techniques such as gene probe hybridization. Members of groups I and IV have to date
been found exclusively in (non-human) animal faeces, and group III in human faeces.
Group II phages have been detected in human faeces and no animal faeces other than
about 28% of porcine faeces. This specificity, which is not fully understood, offers a
potential tool to distinguish between faecal pollution of human and animal origin
under certain conditions and limitations.
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Indicator value
Phages share many properties with human viruses, notably composition, morphology, structure and mode of replication. As a result, coliphages are useful models or
surrogates to assess the behaviour of enteric viruses in water environments and the
sensitivity to treatment and disinfection processes. In this regard, they are superior to
faecal bacteria and could be considered for inclusion in verification and surveillance
monitoring where source waters are known to be affected by human faecal waste.
However, there is no direct correlation between numbers of coliphages and numbers
of enteric viruses. In addition, coliphages cannot be absolutely relied upon as an indicator for enteric viruses. This has been confirmed by the isolation of enteric viruses
from treated and disinfected drinking-water supplies that yielded negative results in
conventional tests for coliphages.
F-RNA coliphages provide a more specific indicator of faecal pollution than
somatic phages. In addition, F-RNA coliphages are better indicators of the behaviour
of enteric viruses in water environments and their response to treatment and disinfection processes than are somatic coliphages. This has been confirmed by studies in
which the behaviour and survival of F-RNA coliphages, somatic phages, faecal bacteria
and enteric viruses have been compared. Available data indicate that the specificity of
F-RNA serogroups (genotypes) for human and animal excreta may prove useful in the
distinction between faecal pollution of human and animal origin. However, there are
shortcomings and conflicting data that need to be resolved, and the extent to which
this tool can be applied in practice remains to be elucidated. Owing to the limitations
of coliphages, they are best used in laboratory investigations, pilot trials and possibly
validation testing. They are not suitable for operational or verification (including surveillance) monitoring.
Source and occurrence
Coliphages are excreted by humans and animals in relatively low numbers. As a result of their respective modes of replication and host specificity, somatic coliphages
are generally excreted by most humans and animals, whereas F-RNA coliphages are
excreted by a variable and generally lower percentage of humans and animals. Available data indicate that in some communities, F-RNA phages are detectable in 10% of
human, 45% of bovine, 60% of porcine and 70% of poultry faecal specimens. Somatic
coliphages have been found to generally outnumber F-RNA phages in water environments by a factor of about 5 and cytopathogenic human viruses by a factor of about
500, although these ratios vary considerably. Sewage contains somatic coliphages in
numbers of the order of 106108 per litre; in one study, slaughterhouse wastewater was
found to contain somatic coliphages in numbers up to 1010 per litre. There are indications that they may multiply in sewage, and somatic coliphages may multiply in natural water environments using saprophytic hosts. Somatic phages and F-RNA phages
have been detected in numbers up to 105 per litre in lake and river water.
Application in practice
Somatic coliphages are detectable by relatively simple and inexpensive plaque assays,
which yield results within 24 hours. Plaque assays for F-RNA coliphages are not quite
302
as simple, because the culture of host bacteria has to be in the logarithmic growth
phase at a temperature above 30 C to ensure that F-fimbriae are present. Plaque
assays using large petri dishes have been designed for the quantitative enumeration
of plaques in 100 ml samples, and presence/absence tests have been developed for
volumes of water of 500 ml or more.
Significance in drinking-water
As coliphages typically replicate in the gastrointestinal tract of humans and warmblooded animals, their presence in drinking-water provides an indicator of faecal
pollution and hence the potential presence of enteric viruses and possibly also other
pathogens. The presence of coliphages in drinking-water also indicates shortcomings
in treatment and disinfection processes designed to remove enteric viruses. F-RNA
coliphages provide a more specific indicator for faecal pollution. The absence of coliphages from treated drinking-water supplies does not confirm the absence of pathogens such as enteric viruses and protozoan parasites.
Selected bibliography
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality. In: Fewtrell
L, Bartram J, eds. Water qualityGuidelines, standards and health: Assessment of risk and
risk management for water-related infectious disease. London, IWA Publishing, pp. 289315
(WHO Water Series).
Grabow WOK (2001) Bacteriophages: Update on application as models for viruses in water.
Water SA, 27:251268.
Mooijman KA et al. (2001) Optimisation of the ISO-method on enumeration of somatic
coliphages (draft ISO 10705-2). Water Science and Technology, 43:205208.
Schaper M et al. (2002) Distribution of genotypes of F-specific RNA bacteriophages in human
and non-human sources of faecal pollution in South Africa and Spain. Journal of Applied
Microbiology, 92:657667.
Storey MV, Ashbolt NJ (2001) Persistence of two model enteric viruses (B40-8 and MS-2
bacteriophages) in water distribution pipe biofilms. Water Science and Technology, 43:133
138.
human origin. However, B. fragilis phages occur in relatively low numbers in sewage,
polluted water environments and drinking-water supplies. This implies that the absence of B. fragilis phages from treated drinking-water supplies does not confirm the
absence of pathogens such as enteric viruses and protozoan parasites.
Selected bibliography
Bradley G et al. (1999) Distribution of the human faecal bacterium Bacteroides fragilis and their
relationship to current sewage pollution indicators in bathing waters. Journal of Applied
Microbiology, 85(Suppl.):90S100S.
Grabow WOK (2001) Bacteriophages: Update on application as models for viruses in water.
Water SA, 27:251268.
Puig A et al. (1999) Diversity of Bacteroides fragilis strains in their capacity to recover phages
from human and animal wastes and from fecally polluted wastewater. Applied and
Environmental Microbiology, 65:17721776.
Storey MV, Ashbolt NJ (2001) Persistence of two model enteric viruses (B40-8 and MS-2
bacteriophages) in water distribution pipe biofilms. Water Science and Technology, 43:133
138.
Tartera C, Lucena F, Jofre J (1989) Human origin of Bacteroides fragilis bacteriophages present
in the environment. Applied and Environmental Microbiology, 10:26962701.
Enteric viruses
General description
The viruses referred to here are a combined group of those that infect the human
gastrointestinal tract and are predominantly transmitted by the faecaloral route.
Well-known members of this group include the enteroviruses, astroviruses, enteric
adenoviruses, orthoreoviruses, rotaviruses, caliciviruses and hepatitis A and E
viruses. The enteric viruses cover a wide spectrum of viruses, members of which
are a major cause of morbidity and mortality worldwide. Members of the group
of enteric viruses differ with regard to structure, composition, nucleic acid and
morphology. There are also differences in the numbers and frequency of excretion,
survival in the environment and resistance to water treatment processes. Enteric
viruses have robust capsids that enable them to survive unfavourable conditions in
the environment as well as allowing passage through the acidic and proteolytic conditions in the stomach on their way to the duodenum, where they infect susceptible
epithelial cells.
Indicator value
The use of enteric viruses as indicator organisms is based on the shortcomings of the
existing choices. The survival of faecal bacteria in water environments and the sensitivity to treatment and disinfection processes differ substantially from those of enteric
viruses. Monitoring based on one or more representatives of the large group of enteric
viruses themselves would therefore be more valuable for assessment of the presence of
any of the enteric viruses in water and the response to control measures.
Source and occurrence
Enteric viruses are excreted by individuals worldwide at a frequency and in numbers
that result in many of these viruses being universally present in substantial numbers
305
in wastewater. However, the prevalence of individual members may vary to a large extent as a result of variations in rates of infection and excretion. Much higher numbers
would be present during outbreaks.
Application in practice
Practical methods are not yet available for the routine monitoring of water supplies
for a broad spectrum of enteric viruses. Viruses that are more readily detectable
include members of the enterovirus, adenovirus and orthoreovirus groups. These
viruses occur in polluted environments in relatively high numbers and can be
detected by reasonably practical and moderate-cost techniques based on cytopathogenic effect in cell culture that yield results within 312 days (depending on the
type of virus). In addition, progress in technology and expertise is decreasing costs.
The cost for the recovery of enteric viruses from large volumes of drinking-water
has been reduced extensively. Some techniquesfor instance, those based on glass
wool adsorptionelutionare inexpensive. The cost of cell culture procedures has
also been reduced. Consequently, the cost of testing drinking-water supplies for
cytopathogenic viruses has become acceptable for certain purposes. Testing could
be used to validate the effectiveness of treatment processes and, in certain circumstances, as part of specific investigations to verify the performance of processes. The
incubation times, cost and relative complexity of testing mean that enteric virus
testing is not suitable for operational or verification (including surveillance) monitoring. Orthoreoviruses, and at least the vaccine strains of polioviruses detected in
many water environments, also have the advantage of not constituting a health risk
to laboratory workers.
Significance in drinking-water
The presence of any enteric viruses in drinking-water should be regarded as an indicator for the potential presence of other enteric viruses, is conclusive evidence of faecal
pollution and also provides evidence of shortcomings in water treatment and disinfection processes.
Selected bibliography
Ashbolt NJ, Grabow WOK, Snozzi M (2001) Indicators of microbial water quality. In: Fewtrell
L, Bartram J, eds. Water qualityGuidelines, standards and health: Assessment of risk and
risk management for water-related infectious disease. London, IWA Publishing, pp. 289315
(WHO Water Series).
Grabow WOK, Taylor MB, de Villiers JC (2001) New methods for the detection of viruses: Call
for review of drinking-water quality guidelines. Water Science and Technology, 43:18.
306
12
Chemical fact sheets
Introduction
(Chapter 1)
Monitoring
Management and
communication
Surveillance
(Chapter 5)
SUPPORTING
INFORMATION
Microbial aspects
(Chapters 7 and 11)
Chemical aspects
(Chapters 8 and 12)
Radiological
aspects
(Chapter 9)
Acceptability
aspects
(Chapter 10)
Guideline value
Occurrence
Limit of detection
Treatment performance
Additional comments
Assessment date
2011
Principal references
in maize and a number of other crops. It is lost from soil mainly through volatilization,
photodegradation and biodegradation. Many alachlor degradation products have
been identified in soil. Alachlor was included in the Prior Informed Consent procedure of the Rotterdam Convention on the basis of the final regulatory actions taken by
the European Community and by Canada to ban alachlor as a pesticide.
Guideline value
Occurrence
Has been detected in groundwater and surface water; has also been
detected in drinking-water at levels below 0.002 mg/l
Limit of detection
Treatment performance
Assessment date
1993
Principal reference
On the basis of available experimental data, evidence for the genotoxicity of alachlor is considered to be equivocal. However, a metabolite of alachlor, 2,6-diethylaniline, has been shown to be mutagenic. Available data from two studies in rats clearly
indicate that alachlor is carcinogenic, causing benign and malignant tumours of the
nasal turbinate, malignant stomach tumours and benign thyroid tumours.
Aldicarb
Aldicarb (CAS No. 116-06-3) is a systemic pesticide used to control nematodes in soil
and insects and mites on a variety of crops. It is very soluble in water and highly mobile in soil. It degrades mainly by biodegradation and hydrolysis, persisting for weeks
to months.
Guideline value
Occurrence
Acceptable daily intake (ADI) 00.003 mg/kg body weight based on cholinesterase depression in a
single oral dose study in human volunteers
Limit of detection
Treatment performance
Additional comments
The guideline value derived from the 1992 assessment of the Joint
FAO/WHO Meeting on Pesticide Residues (JMPR) was very similar to
the guideline value derived in the second edition, which was therefore
retained.
Assessment date
2003
Principal references
Aldicarb is one of the most acutely toxic pesticides in use, although the only consistently observed toxic effect with both long-term and single-dose administration is
acetylcholinesterase inhibition. It is converted to the sulfoxide and sulfone. Aldicarb
sulfoxide is a more potent inhibitor of acetylcholinesterase than aldicarb itself, whereas aldicarb sulfone is considerably less toxic than either aldicarb or the sulfoxide. The
weight of evidence indicates that aldicarb, aldicarb sulfoxide and aldicarb sulfone are
not genotoxic or carcinogenic. IARC has concluded that aldicarb is not classifiable as
to its carcinogenicity (Group 3).
Aldrin and dieldrin
Aldrin (CAS No. 309-00-2) and dieldrin (CAS No. 60-57-1) are chlorinated pesticides that are used against soil-dwelling pests, for wood protection and, in the case
of dieldrin, against insects of public health importance. Since the early 1970s, many
countries have either severely restricted or banned the use of both compounds, particularly in agriculture. The two compounds are closely related with respect to their
toxicology and mode of action. Aldrin is rapidly converted to dieldrin under most
environmental conditions and in the body. Dieldrin is a highly persistent organochlorine compound that has low mobility in soil, can be lost to the atmosphere and
bioaccumulates. Dietary exposure to aldrin/dieldrin is very low and decreasing.
Guideline value
Occurrence
0.1 g/kg body weight (combined total for aldrin and dieldrin), based on
no-observed-adverse-effect levels (NOAELs) of 1 mg/kg diet in the dog
and 0.5 mg/kg diet in the rat, which are equivalent to 0.025 mg/kg body
weight per day in both species, and applying an uncertainty factor of 250
based on concern about carcinogenicity observed in mice
Limit of detection
0.003 g/l for aldrin and 0.002 g/l for dieldrin by GC with electron
capture detector (ECD)
Treatment performance
Additional comments
Assessment date
2003
Principal references
Both compounds are highly toxic in experimental animals, and cases of poisoning in humans have occurred. Aldrin and dieldrin have more than one mechanism of
toxicity. The target organs are the central nervous system and the liver. In long-term
studies, dieldrin was shown to produce liver tumours in both sexes of two strains of
mice. It did not produce an increase in tumours in rats and does not appear to be
genotoxic. IARC has classified aldrin and dieldrin in Group 3 (not classifiable as to its
carcinogenicity to humans). Exposure through food has decreased significantly with
the dramatic reduction in use.
Aluminium
Aluminium is the most abundant metallic element and constitutes about 8% of
Earths crust. Aluminium salts are widely used in water treatment as coagulants to
reduce organic matter, colour, turbidity and microorganism levels. Such use may lead
to increased concentrations of aluminium in finished water. Where residual concentrations are high, undesirable colour and turbidity may ensue. Concentrations of
aluminium at which such problems may occur are highly dependent on a number of
water quality parameters and operational factors at the water treatment plant. Aluminium intake from foods, particularly those containing aluminium compounds used
as food additives, represents the major route of aluminium exposure for the general
public. The contribution of drinking-water to the total oral exposure to aluminium
is usually less than 5% of the total intake.
Reason for not establishing A health-based value of 0.9 mg/l could be derived from the JECFA
a guideline value
provisional tolerable weekly intake (PTWI), but this value exceeds
practicable levels based on optimization of the coagulation process in
drinking-water plants using aluminium-based coagulants: 0.1 mg/l or less
in large water treatment facilities and 0.2 mg/l or less in small facilities
Assessment date
2009
Principal references
There is little indication that orally ingested aluminium is acutely toxic to humans
despite the widespread occurrence of the element in foods, drinking-water and many
antacid preparations. It has been hypothesized that aluminium exposure is a risk factor for the development or acceleration of onset of Alzheimer disease in humans. The
1997 WHO Environmental Health Criteria document for aluminium concludes that:
311
In 2007, JECFA developed a PTWI for aluminium from all sources of 1 mg/kg
body weight. JECFA concluded the following:
the available studies have many limitations and are not adequate for defining the dose
response relationships. The Committee therefore based its evaluation on the combined
evidence from several studies. The relevance of studies involving administration of aluminium compounds by gavage was unclear because the toxicokinetics after gavage were expected to differ from toxicokinetics after dietary administration, and the gavage studies
generally did not report total aluminium exposure including basal levels in the feed. The
studies conducted with dietary administration of aluminium compounds were considered
most appropriate for the evaluation. The lowest LOELs [lowest-observed-effect levels] for
aluminium in a range of different dietary studies in mice, rats and dogs were in the region
of 5075 mg/kg bw [body weight] per day expressed as Al.
The Committee applied an uncertainty factor of 100 to the lower end of this range of
LOELs (50 mg/kg bw per day expressed as Al) to allow for inter- and intraspecies differences. There are deficiencies in the database, notably the absence of NOELs [no-observedeffect levels] in the majority of the studies evaluated and the absence of long-term studies
on the relevant toxicological end-points. The deficiencies are counterbalanced by the
probable lower bioavailability of the less soluble aluminium species present in food.
Overall, an additional uncertainty factor of three was considered to be appropriate. The
Committee confirmed that the resulting health-based guidance value should be expressed
as a PTWI, because of the potential for bioaccumulation. The Committee established a
PTWI of 1 mg/kg bw for Al, which applies to all aluminium compounds in food, including additives.
A health-based value derived from the JECFA PTWI would be 0.9 mg/l (rounded
value), based on an allocation of 20% of the PTWI to drinking-water and assuming
a 60 kg adult drinking 2 litres of water per day. However, there remain uncertainties
as to the extent of aluminium absorption from drinking-water, which depends on a
number of parameters, such as the aluminium salt administered, pH (for aluminium
speciation and solubility), bioavailability and dietary factors.
The beneficial effects of the use of aluminium as a coagulant in water treatment
are recognized. Taking this into account, and considering the health concerns about
aluminium (i.e. its potential neurotoxicity), a practicable level is derived, based on
optimization of the coagulation process in drinking-water plants using aluminiumbased coagulants, to minimize aluminium levels in finished water.
312
Several approaches are available for minimizing residual aluminium concentrations in treated water. These include use of optimum pH in the coagulation process, avoiding excessive aluminium dosage, good mixing at the point of application
of the coagulant, optimum paddle speeds for flocculation and efficient filtration of
the aluminium floc. Under good operating conditions, concentrations of aluminium
of 0.1 mg/l or less are achievable in large water treatment facilities. Small facilities
(e.g.those serving fewer than 10 000 people) might experience some difficulties in
attaining this level, because the small size of the plant provides little buffering for fluctuation in operation; moreover, such facilities often have limited resources and limited
access to the expertise needed to solve specific operational problems. For these small
facilities, 0.2 mg/l or less is a practicable level for aluminium in finished water.
As indicated above, a health-based value derived from the JECFA PTWI would
be 0.9 mg/l (rounded value) based on an allocation of 20% of the PTWI to drinkingwater and assuming a 60 kg adult drinking 2 litres of water per day. However, as also
noted above, practicable levels based on optimization of the coagulation process in
drinking-water plants using aluminium-based coagulants are less than 0.1 mg/l in
large water treatment facilities and less than 0.2 mg/l in small facilities. In view of the
importance of optimizing coagulation to prevent microbial contamination and the
need to minimize deposition of aluminium floc in distribution systems, it is important
to ensure that average residuals do not exceed these values.
Ammonia
The term ammonia includes the non-ionized (NH3) and ionized (NH4+) species.
Ammonia in the environment originates from metabolic, agricultural and industrial
processes and from disinfection with chloramine. Natural levels in groundwater and surface water are usually below 0.2 mg/l. Anaerobic groundwaters may contain up to 3mg/l.
Intensive rearing of farm animals can give rise to much higher levels in surface water.
Ammonia contamination can also arise from cement mortar pipe linings. Ammonia in
water is an indicator of possible bacterial, sewage and animal waste pollution.
Reason for not establishing Occurs in drinking-water at concentrations well below those of health
a guideline value
concern
Assessment date
1993
Principal reference
Antimony
Elemental antimony forms very hard alloys with copper, lead and tin. Antimony compounds have various therapeutic uses. Antimony is used in solders as a replacement
for lead, but there is little evidence of any significant contribution to drinking-water
concentrations from this source. Total exposure from environmental sources, food
and drinking-water is very low compared with occupational exposure.
Guideline value
Occurrence
Tolerable daily intake (TDI) 6 g/kg body weight, based on a NOAEL of 6.0 mg/kg body weight per
day for decreased body weight gain and reduced food and water intake
in a 90-day study in which rats were administered potassium antimony
tartrate in drinking-water, using an uncertainty factor of 1000 (100 for
interspecies and intraspecies variation, 10 for the short duration of the
study)
Limit of detection
Treatment performance
2003
Principal reference
There has been a significant increase in the toxicity data available since the previous review, although much of it pertains to the intraperitoneal route of exposure. The
form of antimony in drinking-water is a key determinant of the toxicity, and it would
appear that antimony leached from antimony-containing materials would be in the
form of the antimony(V) oxo-anion, which is the less toxic form. The subchronic toxicity of antimony trioxide is lower than that of potassium antimony tartrate, which is
the most soluble form. Antimony trioxide, owing to its low bioavailability, is genotoxic
only in some in vitro tests, but not in vivo, whereas soluble antimony(III) salts exert
genotoxic effects in vitro and in vivo. Animal experiments from which the carcinogenic potential of soluble or insoluble antimony compounds may be quantified are
not available. IARC has concluded that antimony trioxide is possibly carcinogenic to
humans (Group 2B) on the basis of an inhalation study in rats, but that antimony
trisulfide was not classifiable as to its carcinogenicity to humans (Group 3). However,
314
chronic oral uptake of potassium antimony tartrate may not be associated with an
additional carcinogenic risk, as antimony after inhalation exposure was carcinogenic
only in the lung but not in other organs and is known to cause direct lung damage following chronic inhalation as a consequence of overload with insoluble particulates. Although there is some evidence for the carcinogenicity of certain antimony compounds
by inhalation, there are no data to indicate carcinogenicity by the oral route.
Arsenic1
Arsenic is found widely in Earths crust in oxidation states of 3, 0, +3 and +5, often as
sulfides or metal arsenides or arsenates. In water, it is mostly present as arsenate (+5),
but in anaerobic conditions, it is likely to be present as arsenite (+3). It is usually present
in natural waters at concentrations of less than 12 g/l. However, in waters, particularly groundwaters, where there are sulfide mineral deposits and sedimentary deposits
deriving from volcanic rocks, the concentrations can be significantly elevated.
Arsenic is found in the diet, particularly in fish and shellfish, in which it is found
mainly in the less toxic organic form. There are only limited data on the proportion of
inorganic arsenic in food, but these indicate that approximately 25% is present in the
inorganic form, depending on the type of food. Apart from occupational exposure,
the most important routes of exposure are through food and drinking-water, including beverages that are made from drinking-water. Where the concentration of arsenic
in drinking-water is 10 g/l or greater, this will be the dominant source of intake. In
circumstances where soups or similar dishes are a staple part of the diet, the drinkingwater contribution through preparation of food will be even greater.
Provisional guideline value 0.01 mg/l (10 g/l)
The guideline value is designated as provisional on the basis of
treatment performance and analytical achievability.
Occurrence
Limit of detection
Treatment performance
s arsenic is one of the chemicals of greatest health concern in some natural waters, its chemical fact sheet
A
has been expanded.
315
Assessment date
2011
Principal references
Both pentavalent and trivalent soluble arsenic compounds are rapidly and extensively absorbed from the gastrointestinal tract. Metabolism is characterized by
1) reduction of pentavalent to trivalent arsenic and 2) oxidative methylation of trivalent arsenic to form monomethylated, dimethylated and trimethylated products.
Methylation of inorganic arsenic facilitates the excretion of inorganic arsenic from
the body, as the end-products monomethylarsonic acid and dimethylarsinic acid are
readily excreted in urine. There are major qualitative and quantitative interspecies
differences in methylation, but in humans and most common laboratory animals, inorganic arsenic is extensively methylated, and the metabolites are excreted primarily
in the urine. There is large interindividual variation in arsenic methylation in humans,
probably due to a wide difference in the activity of methyltransferases and possible
polymorphism. Ingested organoarsenicals are much less extensively metabolized and
more rapidly eliminated in urine than inorganic arsenic.
Arsenic has not been demonstrated to be essential in humans. The acute toxicity
of arsenic compounds in humans is predominantly a function of their rate of removal
from the body. Arsine is considered to be the most toxic form, followed by the arsenites, the arsenates and organic arsenic compounds. Acute arsenic intoxication associated with the ingestion of well water containing very high concentrations (21.0 mg/l)
of arsenic has been reported.
Signs of chronic arsenicism, including dermal lesions such as hyperpigmentation
and hypopigmentation, peripheral neuropathy, skin cancer, bladder and lung cancers
and peripheral vascular disease, have been observed in populations ingesting arsenic-contaminated drinking-water. Dermal lesions were the most commonly observed
symptom, occurring after minimum exposure periods of approximately 5years. Effects
on the cardiovascular system were observed in children consuming arseniccontaminated water (mean concentration 0.6 mg/l) for an average of 7 years.
Numerous epidemiological studies have examined the risk of cancers associated
with arsenic ingestion through drinking-water. Many are ecological-type studies, and
many suffer from methodological flaws, particularly in the measurement of exposure. However, there is overwhelming evidence that consumption of elevated levels
of arsenic through drinking-water is causally related to the development of cancer at
several sites. Nevertheless, there remain considerable uncertainty and controversy over
both the mechanism of carcinogenicity and the shape of the doseresponse curve at
low intakes. The International Programme on Chemical Safety (IPCS) concluded that
long-term exposure to arsenic in drinking-water is causally related to increased risks
of cancer in the skin, lungs, bladder and kidney, as well as other skin changes, such
316
the basis of treatment performance and analytical achievability with the proviso that
every effort should be made to keep concentrations as low as reasonably possible.
Practical considerations
A silver diethyldithiocarbamate spectrophotometric method (ISO 6595:1982)
is available for the determination of arsenic; the detection limit is about 1 g/l.
Graphite furnace AAS, hydride generation AAS and ICP-MS are more sensitive.
HPLC in combination with ICP-MS can also be used to determine various arsenic
species.
It is technically feasible to achieve arsenic concentrations of 5 g/l or lower using
any of several possible treatment methods. However, this requires careful process optimization and control, and a more reasonable expectation is that 10 g/l should be
achievable by conventional treatment (e.g. coagulation). For local non-piped water
supplies, the first option is often substitution by, or dilution with, microbially safe
low-arsenic sources. It may also be appropriate to use alternative sources for drinking
and cooking but to use the contaminated sources for purposes such as washing and
laundry. There are also an increasing number of effective small-scale treatment techniques, usually based around coagulation and precipitation or adsorption, available at
relatively low cost for removal of arsenic from small supplies.
Asbestos
Asbestos is introduced into water by the dissolution of asbestos-containing minerals
and ores as well as from industrial effluents, atmospheric pollution and asbestos-cement
pipes in the distribution system. Exfoliation of asbestos fibres from asbestos-cement
pipes is related to the aggressiveness of the water supply. Limited data indicate that
exposure to airborne asbestos released from tap water during showers or humidification
is negligible.
Reason for not establishing
a guideline value
Assessment date
1993
Principal reference
318
Occurrence
00.02 mg/kg body weight based on the NOAEL for atrazine of 1.8 mg/
kg body weight per day identified on the basis of luteinizing hormone
surge suppression and subsequent disruption of the estrous cycle seen at
3.6mg/kg body weight per day in a 6-month study in rats, using a safety
factor of 100
00.04 mg/kg body weight based on the NOAEL of 1.0 mg/kg body
weight per day identified on the basis of kidney toxicity at 7.8 mg/kg
body weight per day in a 24-month study in rats, using a safety factor of
25, based on kinetic considerations
Limit of detection
Treatment performance
0.1 g/l can be achieved using GAC or powdered activated carbon (PAC);
bankside filtration and nanofiltration are also effective
JMPR considered that the NOAEL for atrazine is protective for the
consequences of neuroendocrine and other adverse effects caused by
prolonged exposure to atrazine and its chloro-s-triazine metabolites.
JMPR was not able to assess the source allocation of atrazine to drinkingwater. As such, the default 20% allocation was chosen, as it will be very
conservative in most countries; in addition, it is expected that exposure of
the public will be primarily through drinking-water.
Assessment date
2011
Principal references
319
JMPR agreed that it is unlikely that atrazine is genotoxic and concluded that
atrazine is not likely to pose a carcinogenic risk to humans, as the mode of carcinogenic action in certain susceptible rat strains is not relevant for human risk assessment. The weight of evidence from the epidemiological studies also did not support
a causal association between exposure to atrazine and the occurrence of cancer in
humans.
In special studies of reproductive toxicity, exposure of rats during early pregnancy
(i.e. the luteinizing hormonedependent period) caused increased pre-implantation
or post-implantation losses, including full-litter resorptions. Attenuation of the luteinizing hormone surge and subsequent disruption of the estrous cycle (characterized by
an increase in days in estrus) were observed at and above 3.65 mg/kg body weight
per day, with a NOAEL of 1.8 mg/kg body weight per day. The effects on the luteinizing hormone surge and disruption of the estrous cycle were further supported by a
number of short-term mechanistic studies. Additional experiments suggested that the
effects of atrazine on luteinizing hormone and prolactin secretion are mediated via a
hypothalamic site of action. JMPR concluded that atrazine was not teratogenic.
Studies using a variety of test systems in vitro and in vivo indicated that modulation of the immune system occurs after exposure to atrazine. However, effects suggestive of impaired function of the immune system were observed only at doses greater
than those shown to affect neuroendocrine function, leading to disruption of the
estrous cycle or developmental effects.
The toxicity profiles and mode of action of the chloro-s-triazine metabolites
are similar to those of atrazine; the potency of these metabolites with regard to their
neuroendocrine-disrupting properties appeared to be similar to that of the parent
compound.
The metabolite hydroxyatrazine does not have the same mode of action or
toxicity profile as atrazine and its chloro-s-triazine metabolites. The main effect of
hydroxyatrazine was kidney toxicity (owing to its low solubility in water, resulting
in crystal formation and a subsequent inflammatory response), and there was no
evidence that hydroxyatrazine has neuroendocrine-disrupting properties. There was
no evidence of carcinogenicity, and hydroxyatrazine did not show genotoxicity in an
adequate range of tests in vitro and in vivo.
Barium
Barium is present as a trace element in both igneous and sedimentary rocks, and barium compounds are used in a variety of industrial applications; however, barium in
water comes primarily from natural sources. Food is the primary source of intake for
the non-occupationally exposed population. However, where barium levels in water
are high, drinking-water may contribute significantly to total intake.
Guideline value
Occurrence
NOAEL in humans
Limit of detection
Treatment performance
Additional comments
Assessment date
2003
Principal references
2003
Principal references
Long-term studies conducted in rats and mice have not indicated a carcinogenic
potential, and a variety of in vitro and in vivo assays have indicated that bentazone
is not genotoxic. A health-based value of 300 g/l can be calculated on the basis of
321
Occurrence
Limit of detection
Treatment performance 0.01 mg/l should be achievable using GAC or air stripping
Additional comments
Assessment date
1993
Principal reference
containing beryllium. Beryllium is not likely to be found in natural water above trace
levels as a result of the insolubility of beryllium oxides and hydroxides in the normal
pH range.
Reason for not establishing Rarely found in drinking-water at concentrations of health concern
a guideline value
Assessment date
2009
Principal references
Occurrence
TDI
0.17 mg/kg body weight, based on a BMDL05 of 10.3 mg/kg body weight
per day for developmental toxicity (decreased fetal body weight in rats)
and an uncertainty factor of 60 (10 for interspecies variation and 6 for
intraspecies variation)
Limit of detection
Treatment performance
Assessment date
Principal reference
Short- and long-term oral exposures to boric acid or borax in laboratory animals
have demonstrated that the male reproductive tract is a consistent target of toxicity.
Testicular lesions have been observed in rats, mice and dogs given boric acid or borax
in food or drinking-water. Developmental toxicity has been demonstrated experimentally in rats, mice and rabbits. Negative results in a large number of mutagenicity
assays indicate that boric acid and borax are not genotoxic. In long-term studies in
mice and rats, boric acid and borax caused no increase in tumour incidence.
Bromate
Sodium and potassium bromate are powerful oxidizers used mainly in permanent
wave neutralizing solutions and the dyeing of textiles using sulfur dyes. Potassium
bromate has also been used as an oxidizer to mature flour during milling, in treating
barley in beer making and in fish paste products, although JECFA has concluded that
the use of potassium bromate in food processing is not appropriate. Bromate is not
normally found in water, but can occur as a result of pollution from industrial sources,
sometimes as a consequence of its presence in contaminated soil. However, the main
source in drinking-water is its formation during ozonation when the bromide ion is
present in water. Bromate may also be formed in hypochlorite solutions produced by
electrolysis of bromide-containing salt.
Provisional guideline
value
Occurrence
324
Limit of detection
2003
Principal reference
Assessment date
2009
Principal reference
f emales) of 4 mg/kg body weight per day, giving an ADI of 00.4 mg/kg body weight,
including a safety factor of 10 for population diversity.
The upper limit of the ADI of 00.4 mg/kg body weight yields an acceptable total
daily intake of 24 mg/person for a 60 kg person. Assuming a relative source contribution of 50%, the drinking-water value for a 60 kg adult consuming 2 litres/day would
be up to 6 mg/l; for a 10 kg child consuming 1 litre/day, the value would be up to
2mg/l. However, the dietary bromide contribution for a 10 kg child would probably
be less than that for an adult. These are reasonably conservative values, and they are
unlikely to be encountered in drinking-water supplies.
Bromide can be involved in the reaction between chlorine and naturally occurring organic matter in drinking-water, forming brominated and mixed chloro-bromo
by-products, such as trihalomethanes (THMs) and halogenated acetic acids (HAAs),
or it can react with ozone to form bromate. The levels of bromide that can result in the
formation of these substances are well below the health-based values suggested above.
This guidance applies specifically to inorganic bromide ion and not to bromate or
organohalogen compounds, for which individual health-based guideline values have
been developed.
Brominated acetic acids
Brominated acetic acids are formed during disinfection of water that contains bromide ions and organic matter. Bromide ions occur naturally in surface water and
groundwater and exhibit seasonal fluctuations in levels. Bromide ion levels can increase as a result of either saltwater intrusion resulting from drought conditions or
pollution. Brominated acetates are generally present in surface water and groundwater
distribution systems at mean concentrations below 5 g/l.
Reason for not establishing
guideline values
Assessment date
2003
Principal references
The database for dibromoacetic acid is considered inadequate for the derivation
of a guideline value. There are no systemic toxicity studies of subchronic duration or
longer. The database also lacks suitable toxicokinetic studies, a carcinogenicity study, a
developmental study in a second species and a multigeneration reproductive toxicity
study. Available mutagenicity data suggest that dibromoacetate is genotoxic.
Data are also limited on the oral toxicity of monobromoacetic acid and bromochloroacetic acid. Limited mutagenicity and genotoxicity data give mixed results for
monobromoacetic acid and generally positive results for bromochloroacetic acid. Data
gaps include subchronic or chronic toxicity studies, multigeneration reproductive
toxicity studies, standard developmental toxicity studies and carcinogenicity studies.
The available data are considered inadequate to establish guideline values for these
chemicals.
326
Cadmium
Cadmium metal is used in the steel industry and in plastics. Cadmium compounds
are widely used in batteries. Cadmium is released to the environment in wastewater,
and diffuse pollution is caused by contamination from fertilizers and local air pollution. Contamination in drinking-water may also be caused by impurities in the zinc
of galvanized pipes and solders and some metal fittings. Food is the main source of
daily exposure to cadmium. The daily oral intake is 1035 g. Smoking is a significant
additional source of cadmium exposure.
Guideline value
Occurrence
PTMI
Limit of detection
Treatment performance
Assessment date
2011
Principal references
Absorption of cadmium compounds is dependent on the solubility of the compounds. Cadmium accumulates primarily in the kidneys and has a long biological
half-life in humans of 1035 years. There is evidence that cadmium is carcinogenic by
the inhalation route, and IARC has classified cadmium and cadmium compounds in
Group 2A (probably carcinogenic to humans). However, there is no evidence of carcinogenicity by the oral route and no clear evidence for the genotoxicity of cadmium.
The kidney is the main target organ for cadmium toxicity.
In its recent evaluation of cadmium, JECFA found that data relating excretion of
the biomarker 2-microglobulin in urine to cadmium excretion in urine for individuals who are 50 years of age and older provided the most reliable basis on which to
determine a critical concentration of cadmium in the urine. Urinary excretion of less
327
than 5.24 g of cadmium per gram creatinine was not associated with an increased
excretion of 2-microglobulin, and the dietary exposure that would result in a urinary
cadmium concentration at the breakpoint of 5.24 g/g creatinine was estimated to be
0.8 g/kg body weight per day or about 25 g/kg body weight per month. Because of
cadmiums exceptionally long half-life, the previous PTWI of 7 g/kg body weight was
withdrawn, and a PTMI of 25 g/kg body weight was established.
Carbaryl
Carbaryl (CAS No. 63-25-2) is a broad-spectrum carbamate insecticide that is used
to control insect pests in crops, trees and ornamental plants. It also has some uses in
public health and veterinary practice. Carbaryl has not been reported in drinkingwater; however, it could occur following overspraying or spillage into surface water.
Exposure through drinking-water is therefore considered to be low unless in exceptional circumstances. The major route of carbaryl intake for the general population is
food, but residues are considered to be relatively low.
Reason for not establishing
a guideline value
Assessment date
2006
Principal references
Carbaryl acts through inhibition of brain cholinesterase, and this is also its
primary mode of toxicity. However, carbaryl is also considered to be a non-genotoxic
carcinogen in mice, in which it causes vascular tumours in males. On this basis, JMPR
established an ADI of 00.008 mg/kg body weight. This was based on a lowest-observedadverse-effect level (LOAEL) of 15 mg/kg body weight per day and application of a
safety factor of 2000 (10 for interspecies variation, 10 for intraspecies variation and 20
to reflect the occurrence of the rare and malignant tumour for which a noeffect level
could not be identified).
A health-based value of 50 g/l (rounded value) can be determined from the
JMPR ADI of 00.008 mg/kg body weight, assuming a 60 kg adult drinking 2 litres
of water per day and allowing 20% of the upper limit of the ADI from drinkingwater. However, carbaryl does not appear to be found in drinking-water at significant
concentrations, and so it is not considered necessary to propose a formal guideline
value.
Carbofuran
Carbofuran (CAS No. 1563-66-2) is used worldwide as a pesticide for many crops.
Residues in treated crops are generally very low or not detectable. The physicochemical properties of carbofuran and the few data on occurrence indicate that drinkingwater from both groundwater and surface water sources is potentially the major route
of exposure.
328
Guideline value
Occurrence
ADI
Limit of detection
0.1 g/l by GC with a nitrogenphosphorus detector; 0.9 g/l by reversedphase HPLC with a fluorescence detector
Treatment performance
Assessment date
1998
Principal references
Carbofuran is highly toxic after acute oral administration. The main systemic
effect of carbofuran poisoning in short-term and long-term toxicity studies appears
to be cholinesterase inhibition. No evidence of teratogenicity has been found in
reproductive toxicity studies. On the basis of available studies, carbofuran does not
appear to be carcinogenic or genotoxic.
Carbon tetrachloride
Carbon tetrachloride is used mainly in the production of chlorofluorocarbon
refrigerants, foam-blowing agents and solvents. However, since the Montreal Protocol
on Substances that Deplete the Ozone Layer (1987) and its amendments (1990 and
1992) established a timetable for the phase-out of the production and consumption
of carbon tetrachloride, manufacture and use have dropped and will continue to drop.
Carbon tetrachloride is released mostly into the atmosphere but also into industrial
wastewater. Although it readily migrates from surface water to the atmosphere, levels
in anaerobic groundwater may remain elevated for months or even years. Although
available data on concentrations in food are limited, the intake from air is expected to
be much greater than that from food or drinking-water.
Guideline value
Occurrence
329
TDI
Limit of detection
Treatment performance
The guideline value is lower than the range of values associated with
upper-bound lifetime excess cancer risks of 104, 105 and 106 calculated
by linear extrapolation.
Assessment date
2003
Principal references
The primary targets for carbon tetrachloride toxicity are liver and kidney. In experiments with mice and rats, carbon tetrachloride proved to be capable of inducing
hepatomas and hepatocellular carcinomas. The doses inducing hepatic tumours were
higher than those inducing cell toxicity. It is likely that the carcinogenicity of carbon
tetrachloride is secondary to its hepatotoxic effects. On the basis of available data, carbon tetrachloride can be considered to be a non-genotoxic compound. Carbon tetrachloride is classified by IARC as being possibly carcinogenic to humans (Group2B):
there is sufficient evidence that carbon tetrachloride is carcinogenic in laboratory
animals, but inadequate evidence in humans.
Chloral hydrate
Chloral hydrate, or trichloroacetaldehyde, can be formed as a by-product of the
chlorination of water containing organic precursor material, such as fulvic and
humic acids. It has been found in drinking-water at concentrations of up to 100 g/l,
but concentrations are usually below 10 g/l. Concentrations are generally higher
in surface water than in groundwater, and concentrations appear to increase during
distribution.
Reason for not establishing Occurs in drinking-water at concentrations well below those of health
a guideline value
concern
Assessment date
2004
Principal references
330
Occurrence
Typical chloramine concentrations of 0.52 mg/l are found in drinkingwater supplies where chloramine is used as a primary disinfectant or to
provide a chlorine residual in the distribution system
331
TDI
94 g/kg body weight, based on a NOAEL of 9.4 mg/kg body weight per
day, the highest dose administered to male rats in a 2year United States
National Toxicology Program (NTP) drinking-water study (although
mean body weights of rats given the highest dose were lower than
those of their respective control groups, it is probable that the lower
body weights were caused by the unpalatability of the drinking-water)
Limit of detection
Treatment performance
allocation to water
weight
consumption
Additional comments
100% of TDI
60 kg adult
2 litres/day
An additional uncertainty factor for possible carcinogenicity was not
applied because equivocal cancer effects reported in the NTP study in
only one species and in only one sex were within the range observed in
historical controls.
Most individuals are able to taste chloramines at concentrations below 5
mg/l, and some at levels as low as 0.3 mg/l.
Assessment date
2003
Principal references
Reason for not establishing Available data inadequate to permit derivation of health-based guideline
guideline values
values for dichloramine and trichloramine
Assessment date
1993
Principal references
Monochloramine
Although monochloramine has been shown to be mutagenic in some in vitro studies,
it has not been found to be genotoxic in vivo. IARC has classified chloramine in Group
3 (not classifiable as to its carcinogenicity to humans). In the NTP bioassay in two species, the incidence of mononuclear cell leukaemias in female rats was increased, but no
other increases in tumour incidence were observed. IPCS did not consider the increase
in mononuclear cell leukaemia to be treatment related.
Dichloramine and trichloramine
Dichloramine and trichloramine have not been extensively studied, and available data
are inadequate to permit derivation of health-based guideline values for either of these
chemicals. However, these substances can cause taste and odour problems (see chapter
10) if formation of monochloramine is not controlled adequately.
332
Chlordane
Chlordane (CAS No. 57-47-9) is a broad-spectrum insecticide that has been used since
1947. Its use has recently been increasingly restricted in many countries, and it is now
used mainly to destroy termites by subsurface injection into soil. Chlordane may be a
low-level source of contamination of groundwater when applied by subsurface injection. Technical chlordane is a mixture of compounds, with the cis and trans forms of
chlordane predominating. It is very resistant to degradation, highly immobile in soil
and unlikely to migrate to groundwater, where it has only rarely been found. It is readily lost to the atmosphere. Although levels of chlordane in food have been decreasing,
it is highly persistent and has a high bioaccumulation potential.
Guideline value
Occurrence
PTDI
0.5 g/kg body weight based on a NOAEL of 50 g/kg body weight per
day for increased liver weights, serum bilirubin levels and incidence of
hepatocellular swelling, derived from a long-term dietary study in rats,
and using an uncertainty factor of 100 (10 each for interspecies and
intraspecies variation)
Limit of detection
Treatment performance
Assessment date
2003
Principal references
333
The main source of human exposure to chloride is the addition of salt to food, and
the intake from this source is usually greatly in excess of that from drinking-water.
Reason for not establishing
a guideline value
Additional comments
Assessment date
1993
Principal reference
Excessive chloride concentrations increase rates of corrosion of metals in the distribution system, depending on the alkalinity of the water. This can lead to increased
concentrations of metals in the supply.
No health-based guideline value is proposed for chloride in drinking-water. However, chloride concentrations in excess of about 250 mg/l can give rise to detectable
taste in water (see chapter 10).
Chlorine
Chlorine is produced in large amounts and widely used both industrially and domestically as an important disinfectant and bleach. In particular, it is widely used in
the disinfection of swimming pools and is the most commonly used disinfectant and
oxidant in drinking-water treatment. In water, chlorine reacts to form hypochlorous
acid and hypochlorites. Concentrations of chlorate and some perchlorates increase
in hypochlorite solutions upon storage at high ambient temperatures or when new
hypochlorite is added to old hypochlorite.
Guideline value
Occurrence
TDI
150 g/kg body weight, derived from a NOAEL for the absence of toxicity
in rodents ingesting chlorine in drinking-water for 2 years
Limit of detection
Treatment performance
334
Assessment date
1993
Principal reference
Levels of chlorite in water reported in one study ranged from 3.2 to 7.0
mg/l; however, the combined levels will not exceed the dose of c hlorine
dioxide applied. Chlorate can also form in hypochlorite solutions on
storage.
TDIs
Limit of detection
335
Treatment performance
80% of TDI
60 kg adult
2 litres/day
Assessment date
2003
Principal references
Chlorine dioxide
Chlorine dioxide has been shown to impair neurobehavioural and neurological development in rats exposed perinatally. Significant depression of thyroid hormones
has also been observed in rats and monkeys exposed to it in drinking-water studies.
A guideline value has not been established for chlorine dioxide because of its rapid
hydrolysis to chlorite and because the provisional guideline value for chlorite is adequately protective for potential toxicity from chlorine dioxide. The taste and odour
threshold for this compound is 0.4 mg/l.
Chlorite
IARC has concluded that chlorite is not classifiable as to its carcinogenicity to humans.
The primary and most consistent finding arising from exposure to chlorite is oxidative
stress resulting in changes in the red blood cells. This end-point is seen in laboratory
animals and, by analogy with chlorate, in humans exposed to high doses in poisoning
incidents. Studies with human volunteers for up to 12 weeks did not identify any effect
on blood parameters at the highest dose tested, 36 g/kg body weight per day.
Chlorate
Like chlorite, the primary concern with chlorate is oxidative damage to red blood cells.
Also like chlorite, a chlorate dose of 36 g/kg body weight per day for 12 weeks did not
result in any adverse effects in human volunteers. Although the database for chlorate is
less extensive than that for chlorite, a well-conducted 90-day study in rats is available.
High doses of chlorate can also interfere with thyroid function.
336
Chloroacetones
1,1-Dichloroacetone is formed from the reaction between chlorine and organic precursors and has been detected in chlorinated drinking-water. Concentrations are
estimated to be less than 10 g/l and usually less than 1 g/l.
Reason for not establishing
guideline values
Assessment date
1993
Principal reference
Occurrence
Limit of detection
Assessment date
1993
Principal reference
Assessment date
1993
Principal reference
337
2-Chlorophenol
Data on the toxicity of 2-chlorophenol are limited. Therefore, no health-based
guideline value has been derived.
2,4-Dichlorophenol
Data on the toxicity of 2,4-dichlorophenol are limited. Therefore, no health-based
guideline value has been derived.
2,4,6-Trichlorophenol
2,4,6-Trichlorophenol has been reported to induce lymphomas and leukaemias in
male rats and hepatic tumours in male and female mice. The compound has not been
shown to be mutagenic in the Ames test but has shown weak mutagenic activity in
other in vitro and in vivo studies. IARC has classified 2,4,6-trichlorophenol in Group
2B (possibly carcinogenic to humans).
Chloropicrin
Chloropicrin, or trichloronitromethane, is formed by the reaction of chlorine with
humic and amino acids and with nitrophenols. Its formation is increased in the presence of nitrates. Limited data from the USA indicate that concentrations in drinkingwater are usually less than 5 g/l.
Reason for not establishing
a guideline value
Assessment date
1993
Principal reference
Decreased survival and body weights have been reported following long-term
oral exposure in laboratory animals. Chloropicrin has been shown to be mutagenic
in bacterial tests and in in vitro assays in lymphocytes. Because of the high mortality
in a carcinogenesis bioassay and the limited number of end-points examined in the
78-week toxicity study, the available data were considered inadequate to permit the
establishment of a guideline value for chloropicrin.
Chlorotoluron
Chlorotoluron (CAS No. 15545-48-9) is a preemergence or early postemergence
herbicide that is slowly biodegradable and mobile in soil. There is only very limited
exposure to this compound from food.
Guideline value
Occurrence
TDI
11.3 g/kg body weight, derived from a NOAEL of 11.3 mg/kg body
weight per day for systemic effects in a 2-year feeding study in mice
using an uncertainty factor of 1000 (100 for interspecies and intraspecies
variation and 10 for evidence of carcinogenicity)
338
Limit of detection
Treatment performance
1993
Principal reference
Chlorotoluron is of low toxicity following single, short-term and long-term exposures in experimental animals, but it has been shown to cause an increase in adenomas and carcinomas of the kidneys of male mice given high doses for 2 years. As
no carcinogenic effects were reported in a 2-year study in rats, it has been suggested
that chlorotoluron has a carcinogenic potential that is both species and sex specific.
Chlorotoluron and its metabolites have shown no evidence of genotoxicity.
Chlorpyrifos
Chlorpyrifos (CAS No. 2921-88-2) is a broad-spectrum organophosphorus insecticide
used for the control of mosquitoes, flies, various crop pests in soil and on foliage, household pests and aquatic larvae. Although it is not recommended for addition to water for
public health purposes by the WHO Pesticide Evaluation Scheme (WHOPES), it may
be used in some countries as an aquatic larvicide for the control of mosquito larvae.
Chlorpyrifos is strongly absorbed by soil and does not readily leach from it, degrading
slowly by microbial action. It has a low solubility in water and great tendency to partition from aqueous phases into organic phases in the environment.
Guideline value
Occurrence
ADI
Limit of detection
Treatment performance
Assessment date
2003
Principal references
JMPR concluded that chlorpyrifos is unlikely to pose a carcinogenic risk to humans. Chlorpyrifos was not genotoxic in an adequate range of studies in vitro and
in vivo. In long-term studies, inhibition of cholinesterase activity was the main
toxicological finding in all species.
Chromium
Chromium is widely distributed in Earths crust. It can exist in valences of +2 to +6. In
general, food appears to be the major source of intake. Chromium(III) is an essential
nutrient.
Provisional guideline value
Occurrence
Limit of detection
Treatment performance
Assessment date
1993
Principal reference
pentahydrate is sometimes added to surface water for the control of algae. Copper
concentrations in drinking-water vary widely, with the primary source most often
being the corrosion of interior copper plumbing. Levels in running or fully flushed
water tend to be low, whereas those in standing or partially flushed water samples are
more variable and can be substantially higher (frequently above1 mg/l). Copper concentrations in treated water often increase during distribution, especially in systems
with an acid pH or high-carbonate waters with an alkaline pH. Food and water are the
primary sources of copper exposure in developed countries. Consumption of standing or partially flushed water from a distribution system that includes copper pipes or
fittings can considerably increase total daily copper exposure, especially for infants fed
formula reconstituted with tap water.
Guideline value
Occurrence
Limit of detection
For adults with normal copper homeostasis, the guideline value should
permit consumption of 2 or 3 litres of water per day, use of a nutritional
supplement and copper from foods without exceeding the tolerable upper
intake level of 10 mg/day or eliciting an adverse gastrointestinal response.
Staining of laundry and sanitary ware occurs at copper concentrations
above 1 mg/l. At levels above 2.5 mg/l, copper imparts an undesirable bitter
taste to water; at higher levels, the colour of water is also impacted.
In most instances where copper tubing is used as a plumbing material,
concentrations of copper will be below the guideline value. However, there
are some conditions, such as highly acidic or aggressive waters, that will
give rise to much higher copper concentrations, and the use of copper
tubing may not be appropriate in such circumstances.
Assessment date
2003
Principal references
IPCS concluded that the upper limit of the acceptable range of oral intake in
adults is uncertain but is most likely in the range of several (more than 2 or 3 mg/day),
but not many, milligrams per day in adults. This evaluation was based solely on studies of gastrointestinal effects of copper-contaminated drinking-water. The available
data on toxicity in experimental animals were not considered helpful in establishing
the upper limit of the acceptable range of oral intake owing to uncertainty about an
appropriate model for humans, but they help to establish a mode of action for the
341
response. The data on the gastrointestinal effects of copper must be used with caution, as the effects observed are influenced by the concentration of ingested copper
to a greater extent than the total mass or dose ingested in a 24-hour period. Recent
studies have delineated the threshold for the effects of copper in drinking-water on the
gastrointestinal tract, but there is still some uncertainty regarding the long-term effects of copper on sensitive populations, such as carriers of the gene for Wilson disease
and other metabolic disorders of copper homeostasis.
Cyanazine
Cyanazine (CAS No. 21725-46-2) is a member of the triazine family of herbicides. It
is used as a pre-emergence and post-emergence herbicide for the control of annual
grasses and broadleaf weeds. It can be degraded in soil and water by microorganisms
and by hydrolysis.
Guideline value
Occurrence
TDI
0.198 g/kg body weight based on a NOAEL of 0.198 mg/kg body weight
for hyperactivity in male rats in a 2-year toxicity/carcinogenicity study,
using an uncertainty factor of 1000 (100 for interspecies and intraspecies
variation and 10 for limited evidence of carcinogenicity)
Limit of detection
Treatment performance
1998
Principal reference
On the basis of the available mutagenicity data on cyanazine, evidence for genotoxicity is equivocal. Cyanazine causes mammary gland tumours in rats but not in
mice. The mechanism of mammary gland tumour development in rats is currently
under investigation and may prove to be hormonal. Cyanazine is also teratogenic in
rats at dose levels of 25 mg/kg body weight per day and higher.
Cyanide
Cyanides can be found in some foods, particularly in some developing countries, and
they are occasionally found in drinking-water, but usually only at very low concentrations. However, there are occasions on which large spills of cyanide, associated with
industry, occur, and these can give rise to very high concentrations in drinking-water
source waters, particularly surface waters.
342
Reason for not establishing Occurs in drinking-water at concentrations well below those of health
a guideline value
concern, except in emergency situations following a spill to a water source
Assessment date
2009
Principal references
Cyanide is highly acutely toxic. It is detoxified in the liver by first-pass metabolism following oral exposure. As a consequence, exposure to a dose spread over
a longer period, through a day, for example, will result in lower toxicity, or higher
tolerance, than the same dose given in a single bolus dose. Exposure to high doses
can give rise to thyroid toxicity as a secondary effect of exposure due to the inhibition
of iodine uptake from the thiocyanate generated through the detoxifying action of
rhodanese. It is difficult to interpret human data in view of the difficulty in assessing
the actual absorbed dose in humans following acute fatal intoxication and the lack of
well-conducted studies on sublethal toxicity.
There is a need for guidance regarding concentrations that would not be of concern
for public health following short-term exposure to cyanide. However, because cyanide is
unlikely to occur in drinking-water at concentrations of health concern, it is considered
unnecessary to derive a formal guideline value for short-term exposure to cyanide.
The data on acute exposure to cyanide are unsuitable for use in deriving a healthbased value for short-term exposure because of the high uncertainty surrounding the
data. Using the NOAEL for effects on the reproductive organs of male rats in a 13week study and an uncertainty factor of 100, a TDI of 0.045 mg/kg body weight can be
derived. Because this health-based value is intended for short-term use and exposure
would not exceed 5 days, it is considered to be acceptable to allocate 40% of the TDI
to drinking-water to allow for exposure to cyanogenic glycosides in food. Therefore,
assuming a 60 kg adult drinking 2 litres of water per day with an allocation of 40%
of the TDI to drinking-water, a health-based value of 0.5 mg/l (rounded value) for
shortterm exposure can be calculated.
This health-based value is well below the level that is normally considered to be
of health concern for humans. Cyanide is rapidly detoxified, and exposure spread
throughout the day will further reduce the potential for effects. This health-based
value would be suitable for use for a limited period of up to 5 days, which is the longest
period likely to be required under the circumstances of such an emergency. However,
it is probable that, in most circumstances, this value will be highly conservative for
short-term exposure.
It should be noted that the lowest reported odour threshold for cyanide in
drinking-water is 0.17 mg/l, which is below the short-term health-based value. It is
therefore possible that a small number of individuals will detect cyanide by odour at
concentrations below the health-based value.
The health-based value relates to total cyanide concentration at the tap, including
cyanide from cyanogen chloride in drinking-water as a by-product of disinfection with
chlorine. Cyanogen chloride rapidly breaks down to cyanide in the distribution system or when ingested. As the low levels of cyanide normally found in drinking-water
343
Limit of detection
Monitoring
344
80% of TDI
60 kg adult
2 litres/day
Assessment date
2003
Principal references
Microcystin-LR is a potent inhibitor of eukaryotic protein serine/threonine phosphatases 1 and 2A. The primary target for microcystin toxicity is the liver, as microcystins cross cell membranes chiefly through the bile acid transporter. Guideline value
derivation was based on an oral 13-week study with mice, supported by an oral 44-day
study with pigs. A large number of poisonings of livestock and wildlife have been recorded. Evidence of tumour promotion has been published. In 2006, IARC classified
microcystin-LR as a possible carcinogen (Group 2B).
Practical considerations
Cyanobacteria occur widely in lakes, reservoirs, ponds and slow-flowing rivers. Where
their excessive growth leads to high cell numbers, sometimes termed bloom events,
their toxins can reach concentrations in raw water that are potentially hazardous to
human health. Blooms occur if concentrations of nutrients (phosphorus and nitrogen) are elevated, particularly in stagnant or very slowly flowing water bodies. Blooms
tend to recur in the same water bodies. Cells of some cyanobacterial species may accumulate at the surface as scums or at the thermocline of thermally stratified reservoirs. Such accumulations may develop rapidly, and they may be of very variable
duration (hours to weeks). In many circumstances, blooms and accumulations are
seasonal.
A variety of resource protection and source management actions are available to
decrease the probability of bloom occurrence. Among these, the most sustainable and
effective measure is to reduce nutrient (particularly phosphorus) concentrations in
the water body to levels sufficiently low to substantially limit the amount of cyanobacterial biomass that can grow. This is achieved by controlling nutrient loads from
sewage effluents and from land areas. The latter involves controlling erosion as well as
the amount of manure and fertilizers spread in the catchment. Further, hydrological
management actions such as water body mixing and flushing can render hydrophysical conditions less suitable for cyanobacteria and thus shift plankton species from
cyanobacteria to others (i.e. planktonic algae such as diatoms) that are less relevant to
human health.
345
As microcystins almost always occur largely cell-bound, any drinking-water treatment that removes particlesi.e. soil or riverbank filtration, flocculation and filtration or dissolved air filtrationcontrols them effectively if the process is optimized to
target their removal. This also applies to the cell-bound fraction of other cyanotoxins.
Process operation should avoid cell rupture and toxin release. Hazardously high concentrations of dissolved cyanotoxins appear to occur less frequently. They are well
removed by most types of activated carbon. Chlorination and ozonation are effective
for the removal of many cyanotoxins at sufficiently high doses and contact times, but
not very effective for saxitoxins. Potassium permanganate is effective for microcystins,
whereas limited or no data are available at present for other toxins. Chlorine dioxide
and chloramine are ineffective for removing cyanotoxins.
Cyanotoxin monitoring is most effectively based on surveillance of source water
for evidence of cyanobacterial blooms or bloom-forming potential (i.e. nutrient levels
and phytoplankton species composition), with vigilance increased where such events
occur. In contrast, monitoring finished water against target cyanotoxin concentrations
is unsatisfactory for determining whether or not it is safe, because of the large variety
of toxins (particularly of microcystins), the lack of guideline values for all but one
(i.e. microcystin-LR) against which to monitor and the lack of analytical standards
for many. Analysis of cyanotoxins is particularly useful for validating and optimizing
the efficacy of control measures such as riverbank filtration or treatment. A caveat in
cyanotoxin analysis is the need for extraction of the cell-bound fraction from the cells;
although this is easy to do, particularly for microcystins, neglecting extraction from
cells will lead to dramatic underestimation of concentrations.
Cyanogen chloride
Cyanogen chloride may be formed as a by-product of chloramination or chlorination
of water. It is also formed by the chlorination of cyanide ion present in raw water.
Reason for not establishing Occurs in drinking-water at concentrations well below those of health
a guideline value
concern
Assessment date
2009
Principal references
Cyanogen chloride is rapidly metabolized to cyanide in the body. There are few
data available on the oral toxicity of cyanogen chloride.
As cyanogen chloride is unlikely to be found in drinking-water at concentrations
that are of health concern, it is considered unnecessary to develop a formal guideline
value for cyanogen chloride. Instead, for guidance purposes, a health-based value is
derived based on cyanide.
Using a NOAEL for cyanide of 4.5 mg/kg body weight per day for minor changes
in the testis in a subchronic study in which rats were exposed through their drinking-water and an uncertainty factor of 100, a TDI for cyanide of 0.045 mg/kg body
weight (corresponding to a cyanogen chloride dose of 0.11 mg/kg body weight) can be
346
erived. In view of the minor nature of the changes observed and the NOAEL in a pred
vious chronic study, it is not considered necessary to include an additional uncertainty
factor to allow for the length of the study. Further, it appears that a dose that may be
toxic in acute poisoning would certainly be tolerated under chronic conditions, owing
to efficient detoxification. Assuming a 60 kg adult drinking 2 litres of water per day
and allowing 20% of the TDI to come from water because of the potential for exposure to cyanogenic glycosides in food, the health-based value for long-term exposure is
0.3 mg/l for cyanide or 0.6 mg/l for cyanogen chloride (rounded values).
Although low concentrations of cyanide in raw waters will be converted to cyanogen chloride by chlorination, cyanogen chloride may also be formed during the
production of chloramines in situ as a residual disinfectant to maintain the hygienic
condition of the distribution system. It is important that treatment be optimized to
minimize the formation of cyanogen chloride while maintaining adequate chloramine
residuals where chloramination is practised.
2,4-D
The term 2,4-D is used here to refer to the free acid, 2,4-dichlorophenoxyacetic acid
(CAS No. 94-75-7). Commercial 2,4-D products are marketed as the free acid, alkali
and amine salts and ester formulations. 2,4-D itself is chemically stable, but its esters
are rapidly hydrolysed to the free acid. 2,4-D is a systemic herbicide used for control
of broad-leaved weeds, including aquatic weeds. 2,4-D is rapidly biodegraded in the
environment. Residues of 2,4-D in food rarely exceed a few tens of micrograms per
kilogram.
Guideline value
Occurrence
ADI
00.01 mg/kg body weight for the sum of 2,4-D and its salts and esters,
expressed as 2,4-D, on the basis of a NOAEL of 1 mg/kg body weight per
day in a 1-year study of toxicity in dogs (for a variety of effects, including
histopathological lesions in kidneys and liver) and a 2-year study of
toxicity and carcinogenicity in rats (for renal lesions)
Limit of detection
Treatment performance
The guideline value applies to 2,4-D, as salts and esters of 2,4-D are rapidly
hydrolysed to the free acid in water.
Assessment date
1998
Principal references
347
Occurrence
TDI
Limit of detection
Treatment performance
allocation to water
weight
consumption
10% of TDI
60 kg adult
2 litres/day
Additional comments
The NOAEL used in the guideline value derivation is similar to the NOAEL
of 2.5 mg/kg body weight per day obtained in a short-term study in dogs
and the NOAEL for hepatocyte hypertrophy of 5 mg/kg body weight per
day obtained in a 3-month study in rats.
Assessment date
1993
Principal reference
348
Chlorophenoxy herbicides, as a group, have been classified in Group 2B (possibly carcinogenic to humans) by IARC. However, the available data from studies in
exposed populations and experimental animals do not permit assessment of the carcinogenic potential to humans of any specific chlorophenoxy herbicide. Therefore,
drinking-water guidelines for these compounds are based on a threshold approach for
other toxic effects.
DDT and metabolites
The structure of dichlorodiphenyltrichloroethane, or DDT (CAS No. 107917-42-0),
permits several different isomeric forms; commercial products consist predominantly
of p,p-DDT. Its use has been restricted or banned in several countries, although DDT
is still used in some countries for the control of vectors that transmit yellow fever,
sleeping sickness, typhus, malaria and other insect-transmitted diseases. DDT and
its metabolites are persistent in the environment and resistant to complete degradation by microorganisms. Food is the major source of intake of DDT and related compounds for the general population, although exposure has significantly decreased as a
consequence of the greatly reduced use of DDT for all except specialist applications.
Guideline value
Occurrence
PTDI
0.01 mg/kg body weight based on a NOAEL of 1 mg/kg body weight per
day for developmental toxicity in rats, applying an uncertainty factor of
100 (for interspecies and intraspecies variation)
Limit of detection
Treatment performance
allocation to water
weight
consumption
Additional comments
1% of PTDI
10 kg child
1 litre/day
DDT is listed under the Stockholm Convention on Persistent Organic
Pollutants. Hence, monitoring may occur in addition to that required by
drinking-water guidelines.
It should be noted that the level of DDT and its metabolites in food has
been falling steadily, and the allocation of 1% of the PTDI may be very
conservative.
The guideline value is derived on the basis of a 10 kg child consuming
1 litre of drinking-water per day, because infants and children may be
exposed to greater amounts of chemicals in relation to their body weight
and because of concern over the bioaccumulation of DDT.
It should be emphasized that the benefits of DDT use in malaria and
other vector control programmes outweigh any health risk from the
presence of DDT in drinking-water.
349
Assessment date
2003
Principal references
A working group convened by IARC classified the DDT complex (the mixture
of the various isomers of DDT and associated compounds) as a non-genotoxic
carcinogen in rodents and a potent promoter of liver tumours. IARC has concluded
that there is insufficient evidence in humans and sufficient evidence in experimental
animals for the carcinogenicity of DDT (Group 2B) based upon liver tumours observed in rats and mice. The results of epidemiological studies of pancreatic cancer,
multiple myeloma, non-Hodgkin lymphoma and uterine cancer did not support
the hypothesis of an association with environmental exposure to the DDT complex.
Conflicting data were obtained with regard to some genotoxic end-points. In most
studies, DDT did not induce genotoxic effects in rodent or human cell systems, nor
was it mutagenic to fungi or bacteria. The United States Agency for Toxic Substances
and Disease Registry concluded that the DDT complex could impair reproduction
and development in several species. Hepatic effects of DDT in rats include increased
liver weights, hypertrophy, hyperplasia, induction of microsomal enzymes, including cytochrome P450, cell necrosis, increased activity of serum liver enzymes and
mitogenic effects, which might be related to a regenerative liver response to high
doses of DDT.
Dialkyltins
The group of chemicals known as the organotins is composed of a large number of
compounds with differing properties and applications. The most widely used organotins are the disubstituted compounds, which are employed as stabilizers in plastics,
including polyvinyl chloride (PVC) water pipes, and the trisubstituted compounds,
which are widely used as biocides.
Reason for not establishing
a guideline value
Assessment date
2003
Principal reference
The disubstituted compounds that may leach from PVC water pipes at low concentrations for a short time after installation are primarily immunotoxins, although
they appear to be of low general toxicity. The data available are insufficient to permit
the proposal of guideline values for individual dialkyltins.
1,2-Dibromo-3-chloropropane
1,2-Dibromo-3-chloropropane (CAS No. 96-12-8), or DBCP, is a soil fumigant that is
highly soluble in water. It has a taste and odour threshold in water of 10 g/l. DBCP was
detected in vegetables grown in treated soils, and low levels have been detected in air.
350
Guideline value
Occurrence
Limit of detection
Treatment performance
Additional comments
Assessment date
1993
Principal reference
On the basis of data from different strains of rats and mice, DBCP was determined
to be carcinogenic in both sexes by the oral, inhalation and dermal routes. DBCP was
also determined to be a reproductive toxicant in humans and several species of laboratory animals. DBCP was found to be genotoxic in a majority of in vitro and in
vivo assays. IARC has classified DBCP in Group 2B based upon sufficient evidence of
carcinogenicity in animals. Recent epidemiological evidence suggests an increase in
cancer mortality in individuals exposed to high levels of DBCP.
1,2-Dibromoethane
1,2-Dibromoethane (CAS No. 106-93-4), or ethylene dibromide, is used as a lead scavenger in tetraalkyl lead petrol and antiknock preparations and as a fumigant for soils,
grains and fruits. However, with the phasing out of leaded petrol and of the use of
1,2-dibromoethane in agricultural applications in many countries, use of this substance has declined significantly. In addition to its continued use as a petrol additive
in some countries, 1,2-dibromoethane is currently used principally as a solvent and as
an intermediate in the chemical industry.
Provisional guideline value
Occurrence
Lower end of the range (and thus more conservative estimate) of lifetime
low-dose cancer risks calculated by linearized multistage modelling of
the incidences of haemangiosarcomas and tumours in the stomach, liver,
lung and adrenal cortex (adjusted for the observed high early mortality,
where appropriate, and corrected for the expected rate of increase in
tumour formation in rodents in a standard bioassay of 104 weeks) of rats
and mice exposed by gavage
Limit of detection
Treatment performance
Assessment date
2003
Principal references
IPCS (1995) Report of the 1994 meeting of the Core Assessment Group
IPCS (1996) 1,2-Dibromoethane
WHO (2003) 1,2-Dibromoethane in drinking-water
Occurrence
Limit of detection
Treatment performance
Additional comments
Assessment date
2004
Principal reference
Occurrence
TDIs
Limit of detection
Treatment performance
353
Additional comments
Guideline values for both 1,2- and 1,4-DCB far exceed their lowest
reported taste thresholds in water of 1 and 6 g/l, respectively.
Assessment date
1993
Principal reference
Reason for not establishing Available data inadequate to permit derivation of health-based guideline
a guideline value
value for 1,3-dichlorobenzene
Assessment date
1993
Principal reference
1,2-Dichlorobenzene
1,2-DCB is of low acute toxicity by the oral route of exposure. Oral exposure to high
doses of 1,2-DCB affects mainly the liver and kidneys. The balance of evidence suggests that 1,2-DCB is not genotoxic, and there is no evidence for its carcinogenicity in
rodents.
1,3-Dichlorobenzene
There are insufficient toxicological data on this compound to permit a guideline value
to be proposed, but it should be noted that it is rarely found in drinking-water.
1,4-Dichlorobenzene
1,4-DCB is of low acute toxicity, but there is evidence that it increases the incidence
of renal tumours in rats and of hepatocellular adenomas and carcinomas in mice after
long-term exposure. IARC has placed 1,4-DCB in Group 2B (possibly carcinogenic to
humans). 1,4-DCB is not considered to be genotoxic, and the relevance for humans of
the tumours observed in experimental animals is doubtful.
1,1-Dichloroethane
1,1-Dichloroethane is used as a chemical intermediate and solvent. There are limited
data showing that it can be present at concentrations of up to 10 g/l in drinkingwater. It is primarily of concern for groundwater.
Reason for not establishing
a guideline value
Assessment date
1993
Principal reference
Occurrence
Limit of detection
Treatment performance
Additional comments
The guideline value of 0.03 mg/l is consistent with the value derived from
IPCS (1998), based on a 105 risk level.
Assessment date
2003
Principal references
IARC has classified 1,2-dichloroethane in Group 2B (possible human carcinogen). It has been shown to produce statistically significant increases in a number of
tumour types in laboratory animals, including the relatively rare haemangiosarcoma,
and the balance of evidence indicates that it is potentially genotoxic. Targets of 1,2dichloroethane toxicity in orally exposed animals included the immune system, central nervous system, liver and kidney. Data indicate that 1,2-dichloroethane is less
potent when inhaled.
1,1-Dichloroethene
1,1-Dichloroethene, or vinylidene chloride, is used mainly as a monomer in the production of polyvinylidene chloride co-polymers and as an intermediate in the synthesis of other organic chemicals. It is an occasional contaminant of drinking-water,
usually being found together with other chlorinated hydrocarbons. There are no data
on levels in food, but levels in air are generally less than 40 ng/m3 except at some
manufacturing sites. 1,1-Dichloroethene is detected in finished drinking-water taken
from groundwater sources at median concentrations of 0.281.2 g/l and in public
drinking-water supplies at concentrations up to 0.5 g/l.
355
Assessment date
2004
Principal references
Occurrence
TDI
Limit of detection
356
Treatment performance
Data on the trans isomer were used to calculate a joint guideline value
for both isomers because toxicity for the trans isomer occurred at a lower
dose than for the cis isomer and because data suggest that the mouse is a
more sensitive species than the rat.
Assessment date
1993
Principal reference
There is little information on the absorption, distribution or excretion of 1,2dichloroethene. However, by analogy with 1,1-dichloroethene, 1,2-dichloroethene
would be expected to be readily absorbed, distributed mainly to the liver, kidneys and
lungs and rapidly excreted. The cis isomer is more rapidly metabolized than the trans
isomer in in vitro systems. Both isomers have been reported to cause increased serum
alkaline phosphatase levels in rodents. In a 3-month study in mice given the trans
isomer in drinking-water, there was a reported increase in serum alkaline phosphatase and reduced thymus and lung weights. Transient immunological effects were also
reported, the toxicological significance of which is unclear. Trans-1,2-dichloroethene
also caused reduced kidney weights in rats, but at higher doses. Only one rat toxicity
study is available for the cis isomer, which produced toxic effects in rats similar in
magnitude to those induced by the trans isomer in mice, but at higher doses. There are
limited data to suggest that both isomers may possess some genotoxic activity. There
is no information on carcinogenicity.
Dichloromethane
Dichloromethane, or methylene chloride, is widely used as a solvent for many purposes, including coffee decaffeination and paint stripping. Exposure from drinkingwater is likely to be insignificant compared with that from other sources.
Guideline value
Occurrence
TDI
Limit of detection
357
Treatment performance
10% of TDI
60 kg adult
2 litres/day
Assessment date
1993
Principal reference
TDI
Limit of detection
Treatment performance
10% of TDI
60 kg adult
2 litres/day
Assessment date
1998
358
Principal reference
1,2-DCP was evaluated by IARC in 1986 and 1987. The substance was classified in
Group 3 (not classifiable as to its carcinogenicity to humans) on the basis of limited evidence for its carcinogenicity in experimental animals and insufficient data with which to
evaluate its carcinogenicity in humans. Results from in vitro assays for mutagenicity were
mixed. The in vivo studies, which were limited in number and design, were negative. In
accordance with the IARC evaluation, the evidence from the long-term carcinogenicity
studies in mice and rats was considered limited, and it was concluded that the use of a
threshold approach for the toxicological evaluation of 1,2-DCP was appropriate.
1,3-Dichloropropane
1,3-Dichloropropane (CAS No. 142-28-9) has several industrial uses and may be
found as a contaminant of soil fumigants containing 1,3-dichloropropene. It is rarely
found in water.
Reason for not establishing
a guideline value
Assessment date
1993
Principal reference
Occurrence
Limit of detection
Treatment performance
Assessment date
1993
Principal reference
Occurrence
TDI
36.4 g/kg body weight, based on a NOAEL of 3.64 mg/kg body weight
per day for renal toxicity in a 2-year dietary study in rats, applying an
uncertainty factor of 100 (for intraspecies and interspecies variation)
Limit of detection
1 g/l to 1 mg/l for various methods commonly used for the determination
of chlorophenoxy herbicides in water, including solvent extraction,
separation by GC, gasliquid chromatography, thin-layer chromatography
or HPLC, with ECD or UV detection
Treatment performance
allocation to water
weight
consumption
10% of TDI
60 kg adult
2 litres/day
Assessment date
1993
Principal reference
3-month study, and effects in a 2-year study included hepatocellular swelling, mild
anaemia, increased incidence of brown pigment in the kidneys (possibly indicative of
slight degeneration of the tubular epithelium) and decreased urinary specific gravity
and protein.
Di(2-ethylhexyl)adipate
Di(2-ethylhexyl)adipate (DEHA) is used mainly as a plasticizer for synthetic resins
such as PVC. Reports of the presence of DEHA in surface water and drinking-water
are scarce, but DEHA has occasionally been identified in drinking-water at levels of a
few micrograms per litre. As a consequence of its use in PVC films, food is the most
important source of human exposure (up to 20 mg/day).
Reason for not establishing
a guideline value
Assessment date
2003
Principal reference
DEHA is of low short-term toxicity; however, dietary levels above 6000 mg/kg
of feed induce peroxisomal proliferation in the liver of rodents. This effect is often
associated with the development of liver tumours. DEHA induced liver carcinomas
in female mice at very high doses, but not in male mice or rats. It is not genotoxic. IARC has placed DEHA in Group3 (not classifiable as to its carcinogenicity
to humans).
A health-based value of 80 g/l can be calculated for DEHA on the basis of a
TDI of 280 g/kg body weight, based on fetotoxicity in rats, and allocating 1% of
the TDI to drinking-water. However, because DEHA occurs at concentrations well
below those of health concern, it is not considered necessary to derive a formal
guideline value.
Di(2-ethylhexyl)phthalate
Di(2-ethylhexyl)phthalate (DEHP) is used primarily as a plasticizer. Exposure among
individuals may vary considerably because of the broad nature of products into which
DEHP is incorporated. In general, food will be the main exposure route.
Guideline value
Occurrence
TDI
25 g/kg body weight, based on a NOAEL of 2.5 mg/kg body weight per
day for peroxisomal proliferation in the liver in rats, using an uncertainty
factor of 100 for interspecies and intraspecies variation
Limit of detection
361
Treatment performance
Assessment date
1993
Principal reference
Occurrence
ADI
00.002 mg/kg body weight based on an apparent NOAEL of 1.2 mg/kg body
weight per day for reproductive performance in a study of reproductive
toxicity in rats, applying an uncertainty factor of 500 (100 for interspecies and
intraspecies variation, 5 to take into consideration concern regarding whether
the NOAEL could be a LOAEL)
362
Assessment date
2003
In studies with human volunteers, dimethoate has been shown to be a cholinesterase inhibitor and a skin irritant. Dimethoate is not carcinogenic to rodents.
JMPR concluded that although in vitro studies indicate that dimethoate has mutagenic potential, this potential does not appear to be expressed in vivo. In a multigeneration study of reproductive toxicity in rats, the NOAEL appeared to be 1.2
mg/kg body weight per day, but there was some indication that reproductive performance may have been affected at lower doses. No data were available to assess
whether the effects on reproductive performance were secondary to inhibition of
cholinesterase. JMPR concluded that it was not appropriate to base the ADI on the
results of the studies of volunteers, as the crucial end-point (reproductive performance) has not been assessed in humans. It was suggested that there may be a need
to re-evaluate the toxicity of dimethoate after the periodic review of the residue
and analytical aspects of dimethoate has been completed if it is determined that
omethoate is a major residue.
1,4-Dioxane
1,4-Dioxane is used as a stabilizer in chlorinated solvents and as a solvent for resins,
oils and waxes, for agricultural and biochemical intermediates and for adhesives,
sealants, cosmetics, pharmaceuticals, rubber chemicals and surface coatings.
Guideline value
Occurrence
TDI
allocation to water
weight
consumption
10% of TDI
60 kg adult
2 litres/day
Limit of detection
Treatment performance
363
Additional comments
Similar guideline values were derived using the TDI approach (assuming
1,4-dioxane is not genotoxic in humans at low doses) and linear
multistage modelling (because the compound clearly induces multiple
tumours in various organs).
Assessment date
2004
Principal reference
1,4-Dioxane caused hepatic and nasal cavity tumours in rodents in most longterm oral studies conducted. Tumours in peritoneum, skin and mammary gland were
also observed in rats given a high dose. Lung tumours were specifically detected after
intraperitoneal injection. Although cohort studies of workers did not reveal any elevation in the incidence of death by cancer, a significant increase in the incidence of
liver cancer was found in a comparative mortality study. However, the evidence is
inadequate for human carcinogenicity assessment because of small samples or lack of
exposure data. A possibly weak genotoxic potential of 1,4-dioxane has been suggested.
IARC has classified 1,4-dioxane in Group 2B (possibly carcinogenic to humans).
Diquat
Diquat (CAS No. 2764-72-9) is a non-selective contact herbicide and crop desiccant.
Diquat may also be used (at or below 1 mg/l) as an aquatic herbicide for the control of
free-floating and submerged aquatic weeds in ponds, lakes and irrigation ditches. Because of its rapid degradation in water and strong adsorption onto sediments, diquat
has rarely been found in drinking-water.
Reason for not establishing
a guideline value
Assessment date
2003
Principal references
hygiene products. Exposure to EDTA from drinking-water will be mostly very low
in comparison with that from other sources. Once EDTA is present in the aquatic
environment, its speciation will depend on the water quality and the presence of trace
metals with which it will combine. The removal of EDTA from communal wastewater
by biodegradation in sewage purification plants is very limited.
Guideline value
Occurrence
ADI
01.9 mg/kg body weight as the free acid (ADI of 02.5 mg/kg body
weight proposed by JECFA for calcium disodium edetate as a food
additive)
Limit of detection
Treatment performance
allocation to water
weight
consumption
Additional comments
Concern has been expressed over the ability of EDTA to complex and
therefore reduce the availability of zinc. However, this is of significance
only at elevated doses substantially in excess of those encountered in the
environment.
Assessment date
1998
Principal reference
Calcium disodium edetate is poorly absorbed from the gut. The long-term
t oxicity of EDTA is complicated by its ability to chelate essential and toxic metals.
Those toxicological studies that are available indicate that the apparent toxicological
effects of EDTA have in fact been due to zinc deficiency as a consequence of complexation. EDTA does not appear to be teratogenic or carcinogenic in experimental
animals. The vast clinical experience of the use of EDTA in the treatment of metal
poisoning has demonstrated its safety in humans.
Endosulfan
Endosulfan (CAS No. 115-29-7) is an insecticide used in countries throughout the
world to control pests on fruit, vegetables and tea and on non-food crops such as
tobacco and cotton. In addition to its agricultural use, it is used in the control of the
tsetse fly, as a wood preservative and for the control of home garden pests. Endosulfan
contamination does not appear to be widespread in the aquatic environment, but
the chemical has been found in agricultural runoff and rivers in industrialized areas
365
Assessment date
2003
Principal references
Occurrence
PTDI
0.2 g/kg body weight, based on a NOAEL of 0.025 mg/kg body weight
per day in a 2-year study in dogs and applying an uncertainty factor of
100 for interspecies and intraspecies variation
Limit of detection
Treatment performance
allocation to water
weight
consumption
10% of PTDI
60 kg adult
2 litres/day
366
Additional comments
Assessment date
2003
Principal references
TDI
0.14 g/kg body weight, on the basis of a LOAEL of 2 mg/kg body weight
per day for forestomach hyperplasia observed in a 2-year gavage study in
rats, adjusting for daily dosing and using an uncertainty factor of 10000
to take into consideration interspecies and intraspecies variation (100),
the use of a LOAEL instead of a NOAEL (10) and carcinogenicity (10)
Limit of detection
0.01 g/l by GC with ECD; 0.1 and 0.5 g/l by GC-MS; 10 g/l by GC with
FID
Treatment performance
10% of TDI
60 kg adult
2 litres/day
Additional comments
Assessment date
2003
Principal reference
367
Occurrence
TDI
97.1 g/kg body weight, based on a NOAEL of 136 mg/kg body weight
per day for hepatotoxicity and nephrotoxicity observed in a limited
6-month study in rats, adjusting for daily dosing and using an uncertainty
factor of 1000 (100 for interspecies and intraspecies variation and 10 for
the limited database and short duration of the study)
Limit of detection
Treatment performance
The guideline value exceeds the lowest reported odour threshold for
ethylbenzene in drinking-water (0.002 mg/l).
Assessment date
1993
Principal reference
Ethylbenzene is readily absorbed by the oral, inhalation or dermal route. In humans, storage in fat has been reported. Ethylbenzene is almost completely converted
to soluble metabolites, which are excreted rapidly in urine. The acute oral toxicity is
low. No definite conclusions can be drawn from limited teratogenicity data. No data
on reproduction, long-term toxicity or carcinogenicity are available. Ethylbenzene has
shown no evidence of genotoxicity in in vitro or in vivo systems.
Fenitrothion
Fenitrothion (CAS No. 122-14-5) is mainly used in agriculture for controlling insects
on rice, cereals, fruits, vegetables, stored grains and cotton and in forest areas. It is also
368
used for the control of flies, mosquitoes and cockroaches in public health programmes
and indoor use. Fenitrothion is stable in water only in the absence of sunlight or
microbial contamination. In soil, biodegradation is the primary route of degradation, although photolysis may also play a role. Fenitrothion residues detected in water
were low (maximum 1.30 g/l) during the spruce budworm spray programme. Following the spraying of forests to control spruce budworm, water samples did not
contain detectable amounts of fenitrothion; post-spray samples contained less than
0.01 g/l. Levels of fenitrothion residues in fruits, vegetables and cereal grains decline
rapidly after treatment, with a half-life of 12 days. Intake of fenitrothion appears to
be primarily (95%) from food.
Reason for not establishing
a guideline value
Assessment date
2003
Principal references
On the basis of testing in an adequate range of studies in vitro and in vivo, JMPR
concluded that fenitrothion is unlikely to be genotoxic. It also concluded that fenitrothion is unlikely to pose a carcinogenic risk to humans. In long-term studies of toxicity, inhibition of cholinesterase activity was the main toxicological finding in all species. A health-based value of 8 g/l can be calculated for fenitrothion on the basis of
an ADI of 00.005 mg/kg body weight, based on a NOAEL of 0.5 mg/kg body weight
per day for inhibition of brain and erythrocyte cholinesterase activity in a 2-year study
of toxicity in rats and supported by a NOAEL of 0.57 mg/kg body weight per day
for inhibition of brain and erythrocyte cholinesterase activity in a 3-month study of
ocular toxicity in rats and a NOAEL of 0.65 mg/kg body weight per day for reduced
food consumption and body weight gain in a study of reproductive toxicity in rats,
and allocating 5% of the upper limit of the ADI to drinking-water. However, because
fenitrothion occurs at concentrations well below those of health concern, it is not
considered necessary to derive a formal guideline value.
Fenoprop
The half-lives for degradation of chlorophenoxy herbicides, including fenoprop (CAS
No. 93-72-1), also known as 2,4,5-trichlorophenoxy propionic acid or 2,4,5-TP, in the
environment are in the order of several days. Chlorophenoxy herbicides are not often
found in food.
Guideline value
Occurrence
TDI
3 g/kg body weight, based on a NOAEL of 0.9 mg/kg body weight for
adverse effects on the liver in a study in which dogs were administered
fenoprop in the diet for 2 years, with an uncertainty factor of 300 (100 for
interspecies and intraspecies variation and 3 for limitations of the database)
369
Limit of detection
Treatment performance
1993
Principal reference
Chlorophenoxy herbicides, as a group, have been classified in Group 2B (possibly carcinogenic to humans) by IARC. However, the available data from studies in
exposed populations and experimental animals do not permit assessment of the carcinogenic potential to humans of any specific chlorophenoxy herbicide. Therefore,
drinking-water guidelines for these compounds are based on a threshold approach for
other toxic effects. Effects observed in long-term studies with dogs given fenoprop in
the diet include mild degeneration and necrosis of hepatocytes and fibroblastic proliferation in one study and severe liver pathology in another study. In rats, increased
kidney weight was observed in two long-term dietary studies.
Fluoride1
Fluorine is a common element that is widely distributed in Earths crust and exists in
the form of fluorides in a number of minerals, such as fluorspar, cryolite and fluorapatite. Traces of fluorides are present in many waters, with higher concentrations often
associated with groundwaters. In some areas rich in fluoride-containing minerals, well
water may contain up to about 10 mg of fluoride per litre, although much higher concentrations can be found. High fluoride concentrations can be found in many parts of
the world, particularly in parts of India, China, Central Africa and South America, but
high concentrations can be encountered locally in most parts of the world. Virtually
all foodstuffs contain at least traces of fluorine. All vegetation contains some fluoride,
which is absorbed from soil and water. Tea in particular can contain high fluoride
concentrations, and levels in dry tea are on average 100 mg/kg.
Fluoride is widely used in dental preparations to combat dental caries, particularly in areas of high sugar intake. These can be in the form of tablets, mouthwashes,
toothpaste, varnishes or gels for local application. In some countries, fluoride may also
be added to table salt or drinking-water in order to provide protection against dental
caries. The amounts added to drinking-water are such that final concentrations are
usually between 0.5 and 1 mg/l. The fluoride in final water is always present as fluoride
ions, whether from natural sources or from artificial fluoridation.
s fluoride is one of the chemicals of greatest health concern in some natural waters, its chemical fact sheet
A
has been expanded.
370
Total daily fluoride exposure can vary markedly from one region to another.
This will depend on the concentration of fluoride in drinking-water and the amount
drunk, levels in foodstuffs and the use of fluoridated dental preparations. In addition,
fluoride exposure in some areas is considerably higher as a consequence of a range of
practices, including the consumption of brick tea and the cooking and drying of food
with high-fluoride coal.
Guideline value
Occurrence
Limit of detection
Treatment performance 1 mg/l should be achievable using activated alumina (not a conventional
treatment process, but relatively simple to install filters)
Additional comments
Assessment date
2003
Principal references
After oral uptake, water-soluble fluorides are rapidly and almost completely
absorbed from the gastrointestinal tract, although this may be reduced by complex
formation with aluminium, phosphorus, magnesium or calcium. There is no difference in absorption between natural or added fluoride in drinking-water. Fluoride in
inhaled particlesfrom high-fluoride coal, for exampleis also absorbed, depending
on the particle size and solubility of the fluoride compounds present. Absorbed fluoride is rapidly distributed throughout the body, where it is incorporated into teeth
and bones, with virtually no storage in soft tissues. Fluoride in teeth and bone can be
371
mobilized after external exposure has ceased or been reduced. Fluoride is excreted via
urine, faeces and sweat.
Fluoride may be an essential element for humans; however, essentiality has not
been demonstrated unequivocally. Meanwhile, there is evidence of fluoride being a
beneficial element with regard to the prevention of dental caries.
To produce signs of acute fluoride intoxication, minimum oral doses of about
1 mg of fluoride per kilogram of body weight were required. Many epidemiological
studies of possible adverse effects of the long-term ingestion of fluoride via drinkingwater have been carried out. These studies clearly establish that high fluoride intakes
primarily produce effects on skeletal tissues (bones and teeth). Low concentrations
provide protection against dental caries, both in children and in adults. The protective
effects of fluoride increase with concentration up to about 2 mg of fluoride per litre of
drinking-water; the minimum concentration of fluoride in drinking-water required
to produce it is approximately 0.5 mg/l. However, fluoride can also have an adverse effect on tooth enamel and may give rise to mild dental fluorosis (prevalence: 1233%)
at drinking-water concentrations between 0.9 and 1.2 mg/l, depending on drinkingwater intake and exposure to fluoride from other sources. Mild dental fluorosis may
not be detectable except by specialist examination. The risk of dental fluorosis will
depend on the total intake of fluoride from all sources and not just the concentration
in drinking-water.
Elevated fluoride intakes can have more serious effects on skeletal tissues. Skeletal
fluorosis (with adverse changes in bone structure) may be observed when drinkingwater contains 36 mg of fluoride per litre, particularly with high water consumption.
Crippling skeletal fluorosis usually develops only where drinking-water contains over
10 mg of fluoride per litre. IPCS concluded that there is clear evidence from India and
China that skeletal fluorosis and an increased risk of bone fractures occur at a total
intake of 14 mg of fluoride per day. This conclusion was supported by a review by the
United States National Research Council in 2006. The relationship between exposure
and response for adverse effects in bone is frequently difficult to ascertain because of
inadequacies in most of the epidemiological studies. IPCS concluded from estimates
based on studies from China and India that for a total intake of 14 mg/day, there is
a clear excess risk of skeletal adverse effects; and there is suggestive evidence of an
increased risk of effects on the skeleton at total fluoride intakes above about 6 mg/day.
Several epidemiological studies are available on the possible association between
fluoride in drinking-water and cancer. IPCS evaluated these studies and concluded that,
overall, the evidence of carcinogenicity in laboratory animals is inconclusive and that
the available evidence does not support the hypothesis that fluoride causes cancer in
humans; however, the data on bone cancer are limited. The results of several epidemiological studies on the possible adverse effects of fluoride in drinking-water on pregnancy
outcome indicate that there is no relationship between the rates of Down syndrome or
congenital malformation and the consumption of fluoridated drinking-water.
There is no evidence to suggest that the guideline value of 1.5 mg/l set in 1984
and reaffirmed in 1993 needs to be revised. Concentrations above this value carry an
increasing risk of dental fluorosis, and much higher concentrations lead to skeletal
372
fluorosis. The value is higher than that recommended for artificial fluoridation of
water supplies, which is usually 0.51.0 mg/l.
In setting national standards or local guidelines for fluoride or in evaluating the
possible health consequences of exposure to fluoride, it is essential to consider the
average daily intake of water by the population of interest and the intake of fluoride
from other sources (e.g. from food and air). Where the intakes are likely to approach,
or be greater than, 6 mg/day, it would be appropriate to consider setting a standard or
local guideline at a concentration lower than 1.5 mg/l.
Practical considerations
Fluoride is usually determined by means of an ion-selective electrode, which makes
it possible to measure the total amount of free and complex-bound fluoride dissolved in water. The method can detect fluoride concentrations in water well below
the guideline value. However, appropriate sample preparation is a critical step in
the accurate quantification of fluoride, especially where only the free fluoride ion is
measured.
A range of treatment technologies are available for both large and small supplies.
Different methods for small supplies are favoured in different countries; these are
based on bone charcoal, contact precipitation, activated alumina and clay. However, in
some areas with high natural fluoride levels in drinking-water, the guideline value may
be difficult to achieve in some circumstances with the treatment technology available.
Large supplies tend to rely on activated alumina or advanced treatment processes such
as reverse osmosis.
Formaldehyde
Formaldehyde occurs in industrial effluents and is emitted into air from plastic materials and resin glues. Formaldehyde in drinking-water results primarily from the oxidation of natural organic matter during ozonation and chlorination. Concentrations
of up to 30 g/l have been found in ozonated drinking-water. Formaldehyde can also
be found in drinking-water as a result of release from polyacetal plastic fittings. Formaldehydes physicochemical properties suggest that it is unlikely to volatilize from
water, so exposure by inhalation during showering is expected to be low.
Reason for not establishing
a guideline value
Assessment date
2004
Principal references
Assessment date
2003
Principal references
Glyphosate and AMPA have similar toxicological profiles, and both are considered to exhibit low toxicity. A health-based value of 0.9 mg/l can be derived based
on the group ADI for AMPA alone or in combination with glyphosate of 00.3 mg/
kg body weight, based upon a NOAEL of 32 mg/kg body weight per day, the highest dose tested, identified in a 26-month study of toxicity in rats fed technical-grade
glyphosate and using an uncertainty factor of 100 (for interspecies and intraspecies
variation).
Because of their low toxicity, the health-based value derived for AMPA alone or
in combination with glyphosate is orders of magnitude higher than concentrations
of glyphosate or AMPA normally found in drinking-water. Under usual conditions,
therefore, the presence of glyphosate and AMPA in drinking-water does not represent
a hazard to human health. For this reason, the establishment of a formal guideline
value for glyphosate and AMPA is not deemed necessary.
374
Guideline value
Occurrence
TDIs
Treatment performance
2003
Principal references
Reason for not establishing Available data inadequate to permit derivation of health-based guideline
guideline values
values for bromochloroacetonitrile and trichloroacetonitrile
Assessment date
2003
Principal references
375
IARC has concluded that dichloroacetonitrile, dibromoacetonitrile, bromochloroacetonitrile and trichloroacetonitrile are not classifiable as to their carcinogenicity in humans. Dichloroacetonitrile and bromochloroacetonitrile have been shown
to be mutagenic in bacterial assays, whereas results for dibromoacetonitrile and trichloroacetonitrile were negative. All four of these halogenated acetonitriles induced
sister chromatid exchange and DNA strand breaks and adducts in mammalian cells in
vitro but were negative in the mouse micronucleus test.
The majority of reproductive and developmental toxicity studies of the halogenated acetonitriles were conducted using tricaprylin as a vehicle for gavage administration
of the compound under study. As tricaprylin was subsequently demonstrated to be a
developmental toxicant that potentiated the effects of trichloroacetonitrile and, presumably, other halogenated acetonitriles, results reported for developmental studies
using tricaprylin as the gavage vehicle are likely to overestimate the developmental
toxicity of these halogenated acetonitriles.
Dichloroacetonitrile
Dichloroacetonitrile induced decreases in body weight and increases in relative liver
weight in short-term studies. Although developmental toxicity has been demonstrated,
the studies used tricaprylin as the vehicle for gavage administration.
Dibromoacetonitrile
Dibromoacetonitrile is currently under analysis for chronic toxicity in mice and rats.
None of the available reproductive or developmental studies were adequate to use in
the quantitative doseresponse assessment. The data gap may be particularly relevant
because cyanide, a metabolite of dibromoacetonitrile, induces male reproductive system toxicity and because of uncertainty regarding the significance of the testes effects
observed in a 14-day NTP rat study.
Bromochloroacetonitrile
Available data are insufficient to serve as a basis for derivation of a guideline value for
bromochloroacetonitrile.
Trichloroacetonitrile
Available data are also insufficient to serve as a basis for derivation of a guideline value
for trichloroacetonitrile. The previous provisional guideline value of 1 g/l was based
on a developmental toxicity study in which trichloroacetonitrile was administered by
gavage in tricaprylin vehicle, and a re-evaluation judged this study to be unreliable in
light of the finding in a more recent study that tricaprylin potentiates the developmental and teratogenic effects of halogenated acetonitriles and alters the spectrum of
malformations in the fetuses of treated dams.
Hardness
Hardness in water is caused by a variety of dissolved polyvalent metallic ions, predominantly calcium and magnesium cations. It is usually expressed as milligrams of
calcium carbonate per litre. Hardness is the traditional measure of the capacity of
376
water to react with soap, hard water requiring considerably more soap to produce a
lather.
Reason for not establishing
a guideline value
Additional comments
Assessment date
Principal reference
Natural and treated waters have a wide range of mineral content, from very low
levels in rainwater and naturally soft and softened water to higher levels in naturally
hard waters. Bottled and packaged waters can be naturally mineralized or naturally soft
or demineralized. Thus, the mineral consumption from drinking-water and cooking
water will vary widely, depending upon location, treatment and water source.
The degree of hardness of drinking-water is important for aesthetic acceptability by consumers (see chapter 10) and for economic and operational considerations.
Many hard waters are softened for those reasons using several applicable technologies.
The choice of the most appropriate conditioning technology will depend on local circumstances (e.g. water quality issues, piping materials, corrosion) and will be applied
either centrally or in individual homes as a consumer preference.
Consumers should be informed of the mineral composition of their water,
whether or not it is modified. The contribution of drinking-water minerals to mineral
nutrition should be considered where changes in supply are proposed or where less
traditional sources, such as recycled water, seawater or brackish water, are processed
and exploited for drinking-water. The treatments used remove most minerals, and
stabilization of water is always necessary prior to distribution.
Drinking-water can be a contributor to calcium and magnesium intake and
could be important for those who are marginal for calcium and magnesium. Where
drinking-water supplies are supplemented with or replaced by demineralized water
that requires conditioning, consideration should be given to adding calcium and magnesium salts to achieve concentrations similar to those that the population received
from the original supply. Modification of calcium and magnesium concentrations in
drinking-water for health reasons should comply with the technical requirements to
provide water suitable for distribution.
Although there is evidence from epidemiological studies for a protective effect
of magnesium or hardness on cardiovascular mortality, the evidence is being debated
and does not prove causality. Further studies are being conducted. There are insufficient data to suggest either minimum or maximum concentrations of minerals at this
time, as adequate intake will depend on a range of other factors. Therefore, no guideline values are proposed.
Heptachlor and heptachlor epoxide
Heptachlor (CAS No. 76-44-8) is a broad-spectrum insecticide, the use of which has
been banned or restricted in many countries. At present, the major use of heptachlor
377
is for termite control by subsurface injection into soil. Heptachlor is quite persistent in
soil, where it is mainly transformed to its epoxide. Heptachlor epoxide (CAS No. 102457-3) is very resistant to further degradation. Heptachlor and heptachlor epoxide bind
to soil particles and migrate very slowly. Heptachlor and heptachlor epoxide have been
found in drinking-water at nanogram per litre levels. Diet is considered to represent
the major source of exposure to heptachlor, although intake is decreasing significantly,
as its use has substantially declined.
Reason for not establishing
a guideline value
Assessment date
2003
Principal references
Prolonged exposure to heptachlor has been associated with damage to the liver
and central nervous system toxicity. In 1991, IARC reviewed the data on heptachlor
and concluded that the evidence for carcinogenicity was sufficient in animals and inadequate in humans, classifying it in Group 2B (possibly carcinogenic to humans).
A health-based value of 0.03 g/l can be calculated for heptachlor and heptachlor
epoxide on the basis of a PTDI of 0.1 g/kg body weight, based on a NOAEL for
heptachlor of 0.025 mg/kg body weight per day from two studies in the dog, taking
into consideration inadequacies of the database and allocating 1% of the PTDI to
drinking-water. However, because heptachlor and heptachlor epoxide occur at concentrations well below those of health concern, it is not considered necessary to derive
a formal guideline value. It should also be noted that concentrations below 0.1g/l are
generally not achievable using conventional treatment technology.
Hexachlorobenzene
The major agricultural application for hexachlorobenzene (CAS No. 118-74-1), or
HCB, was as a seed dressing for crops to prevent the growth of fungi, but its use is now
uncommon. At present, it appears mainly as a by-product of several chemical processes or an impurity in some pesticides. HCB is distributed throughout the environment because it is mobile and resistant to degradation. It bioaccumulates in organisms
because of its physicochemical properties and its slow elimination. HCB is commonly
detected at low levels in food, and it is generally present at low concentrations in ambient air. It has been detected only infrequently, and at very low concentrations (below
0.1 g/l), in drinking-water supplies.
Reason for not establishing
a guideline value
Assessment date
2003
Principal references
IARC has evaluated the evidence for the carcinogenicity of HCB in animals and
humans and assigned it to Group 2B (possibly carcinogenic to humans). HCB has been
shown to induce tumours in three animal species and at a variety of sites. A health
based value of 1 g/l can be derived for HCB by applying the linearized multistage
low-dose extrapolation model to liver tumours observed in female rats in a 2-year
dietary study. Using an alternative (tumorigenic dose05, or TD05) approach, a TDI of
0.16 g/kg body weight can be calculated, which corresponds to a health-based value of
approximately 0.05 g/l, if one assumes a 1% allocation of the TDI to drinking-water.
It should be noted that concentrations in food have been falling steadily, and this allocation factor may be considered very conservative.
Because the health-based values derived from both of these approaches are considerably higher than the concentrations at which HCB is detected in drinking-water
(i.e. sub-nanograms per litre), when it is detected, it is not considered necessary to
establish a formal guideline value for HCB in drinking-water. HCB is listed under the
Stockholm Convention on Persistent Organic Pollutants.
Hexachlorobutadiene
Hexachlorobutadiene, or HCBD, is used as a solvent in chlorine gas production, a
pesticide, an intermediate in the manufacture of rubber compounds and a lubricant.
Concentrations of up to 6 g/l have been reported in the effluents from chemical
manufacturing plants. HCBD is also found in air and food.
Guideline value
Occurrence
TDI
0.2 g/kg body weight, based on a NOAEL of 0.2 mg/kg body weight
per day for renal toxicity in a 2-year feeding study in rats, using an
uncertainty factor of 1000 (100 for interspecies and intraspecies
variation and 10 for limited evidence of carcinogenicity and
genotoxicity of some metabolites)
Limit of detection
Treatment performance
The practical quantification limit for HCBD is of the order of 2 g/l, but
concentrations in drinking-water can be controlled by specifying the
HCBD content of products coming into contact with it.
Assessment date
2003
Principal references
379
HCBD is easily absorbed and metabolized via conjugation with glutathione. This
conjugate can be further metabolized to a nephrotoxic derivative. Kidney tumours
were observed in a long-term oral study in rats. HCBD has not been shown to be
carcinogenic by other routes of exposure. IARC has placed HCBD in Group 3 (not
classifiable as to its carcinogenicity to humans). Positive and negative results for
HCBD have been obtained in bacterial assays for point mutation; however, several
metabolites have given positive results.
Hydrogen sulfide
Hydrogen sulfide is a gas with an offensive rotten eggs odour that is detectable at very
low concentrations, below 0.8 g/m3 in air. It is formed when sulfides are hydrolysed
in water. However, the level of hydrogen sulfide found in drinking-water will usually
be low, because sulfides are readily oxidized in well-aerated or chlorinated water.
Reason for not establishing
a guideline value
Additional comments
Assessment date
1993
Principal reference
The acute toxicity to humans of hydrogen sulfide following inhalation of the gas
is high; eye irritation can be observed at concentrations of 1530 mg/m3. Although
oral toxicity data are lacking, it is unlikely that a person could consume a harmful
dose of hydrogen sulfide from drinking-water. Consequently, no guideline value is
proposed. However, hydrogen sulfide can be easily detected in drinking-water by taste
or odour (see chapter 10).
Inorganic tin
Tin is used principally in the production of coatings used in the food industry. Food,
particularly canned food, therefore represents the major route of human exposure
to tin. For the general population, drinking-water is not a significant source of tin,
and levels in drinking-water greater than 12 g/l are exceptional. However, there is
increasing use of tin in solder, which may be used in domestic plumbing, and tin has
been proposed for use as a corrosion inhibitor.
Reason for not establishing
a guideline value
Assessment date
2003
Principal reference
Tin and inorganic tin compounds are poorly absorbed from the gastrointestinal
tract, do not accumulate in tissues and are rapidly excreted, primarily in faeces.
380
Assessment date
1993
Principal reference
as a result of the use of iron coagulants or the corrosion of steel and cast iron pipes
during water distribution.
Reason for not establishing
a guideline value
Additional comments
Assessment date
1993
Principal reference
Iron is an essential element in human nutrition, particularly in the iron(II) oxidation state. Estimates of the minimum daily requirement for iron depend on age,
sex, physiological status and iron bioavailability and range from about 10 to 50 mg/
day.
As a precaution against storage in the body of excessive iron, in 1983, JECFA established a PMTDI of 0.8 mg/kg body weight, which applies to iron from all sources
except for iron oxides used as colouring agents and iron supplements taken during
pregnancy and lactation or for specific clinical requirements. An allocation of 10% of
this PMTDI to drinking-water gives a value of about 2 mg/l, which does not present a
hazard to health. The taste and appearance of drinking-water will usually be affected
below this level (see chapter 10).
No guideline value for iron in drinking-water is proposed.
Isoproturon
Isoproturon (CAS No. 34123-59-6) is a selective, systemic herbicide used in the control
of annual grasses and broad-leaved weeds in cereals. It can be photodegraded, hydrolysed and biodegraded and persists for periods ranging from days to weeks. It is mobile
in soil. There is evidence that exposure to this compound through food is low.
Guideline value
Occurrence
TDI
Limit of detection
Treatment performance
382
Assessment date
1993
Principal reference
Isoproturon is of low acute toxicity and low to moderate toxicity following shortterm and long-term exposures. It does not possess significant genotoxic activity, but
it causes marked enzyme induction and liver enlargement. Isoproturon caused an
increase in hepatocellular tumours in male and female rats, but this was apparent only
at doses that also caused liver toxicity. Isoproturon appears to be a tumour promoter
rather than a complete carcinogen.
Lead
Lead is used principally in the production of lead-acid batteries, solder and alloys. The
organolead compounds tetraethyl and tetramethyl lead have also been used extensively
as antiknock and lubricating agents in petrol, although their use for these purposes
in many countries has largely been phased out. Owing to the decreasing use of leadcontaining additives in petrol and of lead-containing solder in the food processing
industry, concentrations in air and food are declining; in most countries, lead levels
in blood are also declining unless there are specific sources, such as dust from leaded
paint or household recycling of lead-containing materials. Lead is rarely present in tap
water as a result of its dissolution from natural sources; rather, its presence is primarily
from corrosive water effects on household plumbing systems containing lead in pipes,
solder, fittings or the service connections to homes. The amount of lead dissolved
from the plumbing system depends on several factors, including pH, temperature,
water hardness and standing time of the water, with soft, acidic water being the most
plumbosolvent. Free chlorine residuals in drinking-water tend to form more insoluble lead-containing sediments, whereas chloramine residuals may form more soluble
sediments in lead pipe.
Provisional guideline value
Occurrence
The guideline value was previously based on a JECFA PTWI, which has
since been withdrawn, and no new PTWI has been established, on the
basis that there does not appear to be a threshold for the key effects
of lead. However, substantial efforts have been made to reduce lead
exposure from a range of sources, including drinking-water. Because it
is extremely difficult to achieve a lower concentration by central conditioning, such as phosphate dosing, the guideline value is maintained
at 10 g/l but is designated as provisional on the basis of treatment
performance and analytical achievability.
383
Limit of detection
Treatment performance
Additional comments
Assessment date
2011
Principal reference
Lindane
Lindane (-hexachlorocyclohexane; -HCH) (CAS No. 58-89-9) is used as an insecticide on fruit and vegetable crops, for seed treatment and in forestry. It is also used as a
therapeutic pesticide in humans and animals. Several countries have restricted the use
of lindane. Lindane can be degraded in soil and rarely leaches to groundwater. In surface waters, it can be removed by evaporation. Exposure of humans occurs mainly via
food, but this is decreasing. There may also be exposure from its use in public health
and as a wood preservative.
Guideline value
Occurrence
ADI
Limit of detection
Treatment performance
Additional comments
Assessment date
2003
Principal references
Lindane was toxic to the kidney and liver after administration orally, dermally
or by inhalation in short-term and long-term studies of toxicity and reproductive
toxicity in rats. The renal toxicity of lindane was specific to male rats and was considered not to be relevant to human risk assessment, as it is a consequence of accumulation of 2u-globulin, a protein that is not found in humans. Hepatocellular
hypertrophy was observed in a number of studies in mice, rats and rabbits and was
reversed only partially after recovery periods of up to 6weeks. Lindane did not induce
a carcinogenic response in rats or dogs, but it caused an increased incidence of adenomas and carcinomas of the liver in agouti and pseudoagouti mice, but not in black
or any other strains of mice, in a study of the role of genetic background in the latency
and incidence of tumorigenesis. JMPR concluded that there was no evidence of genotoxicity. In the absence of genotoxicity and on the basis of the weight of the evidence
385
from the studies of carcinogenicity, JMPR concluded that lindane is not likely to pose
a carcinogenic risk to humans. Further, in an epidemiological study designed to assess
the potential association between breast cancer and exposure to chlorinated pesticides, no correlation with lindane was found.
Malathion
Malathion (CAS No. 121-75-5) is commonly used to control mosquitoes and a variety of insects that attack fruits, vegetables, landscaping plants and shrubs. It can also
be found in other pesticide products used indoors, on pets to control ticks and insects and to control human head and body lice. Under least favourable conditions
(i.e. low pH and little organic content), malathion may persist in water with a half-life
of months or even years. However, under most conditions, the half-life appears to be
roughly 714 days. Malathion has been detected in surface water and drinking-water
at concentrations below 2 g/l.
Reason for not establishing
a guideline value
Assessment date
2003
Principal references
enhancer in petrol in North America. Manganese greensands are used in some locations for potable water treatment. Manganese is naturally occurring in many surface
water and groundwater sources, particularly in anaerobic or low oxidation conditions, and this is the most important source for drinking-water. Manganese occurs
naturally in many food sources, and the greatest exposure to manganese is usually
from food.
Reason for not establishing
a guideline value
Additional comments
Assessment date
Principal references
Guideline value
Occurrence
TDI
0.5 g/kg body weight, based on a NOAEL of 0.15 mg/kg body weight for
renal and liver toxicity observed at higher dose levels in a 1-year feeding
study in dogs, with an uncertainty factor of 300 (100 for interspecies and
intraspecies variation and 3 for inadequacies of the database)
Limit of detection
Treatment performance
1993
Principal reference
There are only limited and inconclusive data on the genotoxicity of MCPA. IARC
evaluated MCPA in 1983 and concluded that the available data on humans and experimental animals were inadequate for an evaluation of carcinogenicity. Further evaluations by IARC on chlorophenoxy herbicides in 1986 and 1987 concluded that evidence
for their carcinogenicity was limited in humans and inadequate in animals (Group
2B). Recent carcinogenicity studies on rats and mice did not indicate that MCPA
was carcinogenic. No adequate epidemiological data on exposure to MCPA alone are
available.
Mecoprop
The half-lives for degradation of chlorophenoxy herbicides, including mecoprop
(CAS No. 93-65-2; 7085-19-0 racemic mixture), also known as 2(2-methyl-chlorophenoxy)propionic acid or MCPP, in the environment are in the order of several days.
Chlorophenoxy herbicides are not often found in food.
Guideline value
Occurrence
TDI
3.33 g/kg body weight, based on a NOAEL of 1 mg/kg body weight for
effects on kidney weight in 1- and 2-year studies in rats, with an uncertainty factor of 300 (100 for interspecies and intraspecies variation and 3
for limitations of the database)
Limit of detection
Treatment performance
388
allocation to water
weight
consumption
10% of TDI
60 kg adult
2 litres/day
Assessment date
1993
Principal reference
Chlorophenoxy herbicides, as a group, have been classified in Group 2B (possibly carcinogenic to humans) by IARC. However, the available data from studies in
exposed populations and experimental animals do not permit assessment of the carcinogenic potential to humans of any specific chlorophenoxy herbicide. Therefore,
drinking-water guidelines for these compounds are based on a threshold approach for
other toxic effects. Effects of dietary administration of mecoprop in short-term and
long-term studies include decreased relative kidney weight (rats and dogs), increased
relative liver weight (rats), effects on blood parameters (rats and dogs) and depressed
body weight gain (dogs).
Mercury
Mercury is used in the electrolytic production of chlorine, in electrical appliances, in
dental amalgams and as a raw material for various mercury compounds. Methylation of inorganic mercury has been shown to occur in fresh water and in seawater,
although almost all mercury in uncontaminated drinking-water is thought to be in
the form of Hg2+. Thus, it is unlikely that there is any direct risk of the intake of organic mercury compounds, especially of alkylmercurials, as a result of the ingestion of
drinking-water. However, there is a possibility that methylmercury will be converted
into inorganic mercury. Food is the main source of mercury in non-occupationally
exposed populations; the mean dietary intake of mercury in various countries ranges
from 2 to 20 g/day per person.
Guideline value
Occurrence
TDI
Limit of detection
0.05 g/l by cold vapour AAS; 0.6 g/l by ICP; 5 g/l by flame AAS
Treatment performance
389
Assessment date
2004
Principal references
The toxic effects of inorganic mercury compounds are seen mainly in the kidney
in both humans and laboratory animals following short-term and long-term exposure. In rats, effects include increased absolute and relative kidney weights, tubular
necrosis, proteinuria and hypoalbuminaemia. In humans, acute oral poisoning results
primarily in haemorrhagic gastritis and colitis; the ultimate damage is to the kidney.
The overall weight of evidence is that mercury(II) chloride has the potential to increase the incidence of some benign tumours at sites where tissue damage is apparent
and that it possesses weak genotoxic activity but does not cause point mutations.
Methoxychlor
Methoxychlor (CAS No. 72-43-5) is an insecticide used on vegetables, fruit, trees, fodder and farm animals. It is poorly soluble in water and highly immobile in most agricultural soils. Under normal conditions of use, methoxychlor does not seem to be
of environmental concern. Daily intake from food and air is expected to be below 1
g per person. Environmental metabolites are formed preferentially under anaerobic
rather than aerobic conditions and include mainly the dechlorinated and demethylated products. There is some potential for the accumulation of the parent compound
and its metabolites in surface water sediments.
Guideline value
Occurrence
TDI
Limit of detection
0.0010.01 g/l by GC
Treatment performance
390
1993
Principal reference
Assessment date
2003
Principal references
A NOAEL of 0.3 mg/kg body weight per day was derived from the combined results of several studies conducted in humans, based on the depression of erythrocyte
and plasma cholinesterase activities. Methyl parathion decreased cholinesterase activities in long-term studies in mice and rats, but did not induce carcinogenic effects.
Methyl parathion was mutagenic in bacteria, but there was no evidence of genotoxicity
in a limited range of studies in mammalian systems.
391
A health-based value of 9 g/l can be calculated for methyl parathion on the basis
of an ADI of 00.003 mg/kg body weight, based on a NOAEL of 0.25 mg/kg body
weight per day in a 2-year study in rats for retinal degeneration, sciatic nerve demyelination, reduced body weight, anaemia and decreased brain acetylcholinesterase
activity, using an uncertainty factor of 100 for interspecies and intraspecies variation.
As the toxicological end-points seen in experimental animals were other than acetylcholinesterase inhibition, it was considered more appropriate to use these data rather
than the NOAEL derived for cholinesterase inhibition in humans.
Intake of methyl parathion from all sources is generally low and well below the
upper limit of the ADI. As the health-based value is much higher than concentrations
of methyl parathion likely to be found in drinking-water, the presence of methyl parathion in drinking-water under usual conditions is unlikely to represent a hazard to human health. For this reason, the establishment of a formal guideline value for methyl
parathion is not deemed necessary.
Methyl tertiary-butyl ether
The major use of methyl tert-butyl ether, or MTBE, is as a gasoline additive. Surface
water can be contaminated by gasoline spills; however, owing to the high volatility of
MTBE, most is lost to evaporation. Spills and leaking storage tanks can cause more
serious problems in groundwater, where MTBE is more persistent. MTBE has been
detected in groundwater and drinking-water at concentrations in the nanogram to
microgram per litre range.
Reason for not establishing
a guideline value
Assessment date
2004
Principal references
No human cancer studies have been published for either the general population
or occupationally exposed cohorts. There have been a number of human studies of
neurological and clinical effects of exposure to MTBE by inhalation, with mixed results. In general, no objective changes could be seen at levels of MTBE normally found,
even in such microenvironments as gasoline filling stations.
The weight of evidence suggests that MTBE is not genotoxic. A large number of
studies using in vitro and in vivo mammalian and non-mammalian systems have been
conducted to assess the mutagenicity of MTBE, almost all of which have produced
negative results. These results suggest that the mechanism of action of MTBE is more
likely to be non-genotoxic than genotoxic, although no one mechanism appears to
explain all of the observed effects.
It has been concluded that MTBE should be considered a rodent carcinogen but
that it is not genotoxic, and the carcinogenic response is evident only at high levels of
exposure that also induce other adverse effects. The available data are therefore considered inconclusive and prohibit their use for human carcinogenic risk assessment.
392
A health-based guideline value has not been derived for MTBE, owing to the fact that
any guideline value that would be derived would be significantly higher than the concentration at which it would be detected by odour (15 g/l is the lowest level eliciting
a response in a study using taste- and odour-sensitive participants).
Metolachlor
Metolachlor (CAS No. 51218-45-2) is a selective pre-emergence herbicide used on a
number of crops. It can be lost from the soil through biodegradation, photodegradation and volatilization. It is fairly mobile and under certain conditions can contaminate
groundwater, but it is mostly found in surface water.
Guideline value
Occurrence
TDI
3.5 g/kg body weight, based on a NOAEL of 3.5 mg/kg body weight for
an apparent decrease in kidney weight at the two highest dose levels in a
1-year dog study, with an uncertainty factor of 1000 (100 for interspecies
and intraspecies variation and 10 reflecting some concern regarding
carcinogenicity)
Limit of detection
Treatment performance
allocation to water
weight
consumption
10% of TDI
60 kg adult
2 litres/day
Assessment date
1993
Principal reference
Guideline value
Occurrence
TDI
Limit of detection
Treatment performance
1993
Principal reference
On the basis of the limited information available, molinate does not seem to be carcinogenic or mutagenic in experimental animals. Evidence suggests that impairment of
the reproductive performance of the male rat represents the most sensitive indicator of
molinate exposure. However, epidemiological data based on the examination of workers involved in molinate production do not indicate any effect on human fertility.
Molybdenum
Molybdenum is found naturally in soil and is used in the manufacture of special steels
and in the production of tungsten and pigments, and molybdenum compounds are
used as lubricant additives and in agriculture to prevent molybdenum deficiency in
crops. Concentrations in drinking-water are usually less than 0.01 mg/l, although
concentrations as high as 200 g/l have been reported in areas near mining sites.
Reason for not establishing
a guideline value
Assessment date
Principal references
Monochloroacetic acid
Chlorinated acetic acids are formed from organic material during water chlorination.
Guideline value
Occurrence
TDI
3.5 g/kg body weight, based on a LOAEL of 3.5 mg/kg body weight per
day from a study in which increased absolute and relative spleen weights
were observed in male rats exposed to monochloroacetic acid in drinkingwater for 2 years, using an uncertainty factor of 1000 (100 for interspecies
and intraspecies variation and 10 for use of a minimal LOAEL instead of a
NOAEL and database deficiencies, including the lack of a multigeneration
reproductive toxicity study)
Limit of detection
Treatment performance
No information available
2003
Principal reference
Assessment date
2003
Principal reference
MCB is of low acute toxicity. Oral exposure to high doses of MCB results in effects
mainly on the liver, kidneys and haematopoietic system. There is limited evidence of
395
carcinogenicity in male rats, with high doses increasing the occurrence of neoplastic
nodules in the liver. The majority of evidence suggests that MCB is not mutagenic;
although it binds to DNA in vivo, the level of binding is low.
A health-based value of 300 g/l can be calculated for MCB on the basis of a TDI
of 85.7 g/kg body weight, based on neoplastic nodules identified in a 2-year rat study
with dosing by gavage, and taking into consideration the limited evidence of carcinogenicity. However, because MCB occurs at concentrations well below those of health
concern, it is not considered necessary to derive a formal guideline value. It should
also be noted that the health-based value far exceeds the lowest reported taste and
odour threshold for MCB in water.
MX
MX, which is the common name for 3-chloro-4-dichloromethyl-5-hydroxy-2(5H)-furanone, is formed by the reaction of chlorine with complex organic matter
in drinking-water. It has been identified in chlorinated humic acid solutions and
drinking-water in Finland, the United Kingdom and the USA and was found to be
present in 37 water sources at levels of 267 ng/l. Five drinking-water samples from
different Japanese cities contained MX at concentrations ranging from less than 3 to
9 ng/l.
Reason for not establishing
a guideline value
Assessment date
2003
Principal references
of non-resistant material in wells or of water that has come into contact with nickelor chromium-plated taps, the nickel contribution from water may be significant.
Guideline value
Occurrence
TDI
Limit of detection
Treatment performance
allocation to water
weight
consumption
Additional comments
20% of TDI
60 kg adult
2 litres/day
Although the guideline value is close to the acute LOAEL, the LOAEL
is based on total exposure from drinking-water, and absorption from
drinking-water on an empty stomach is 10- to 40-fold higher than
absorption from food. Basing the total acceptable intake for oral
challenge from studies using drinking-water on an empty stomach in
fasted patients can therefore be considered a worst-case scenario.
A general toxicity value of 130 g/l could be determined from a wellconducted two-generation study in rats. However, this general toxicity
value may not be sufficiently protective of individuals sensitized to nickel,
for whom a sufficiently high oral challenge has been shown to elicit an
eczematous reaction.
Assessment date
2004
Principal reference
397
Occurrence
s nitrate and nitrite are chemicals of significant concern in some natural waters, the chemical fact sheet
A
on nitrate and nitrite has been expanded.
398
Limit of detection
Treatment performance Nitrate: 5 mg/l or lower should be achievable using biological denitrification
(surface waters) or ion exchange (groundwaters)
Nitrite: 0.1 mg/l should be achievable using chlorination (to form nitrate)
Additional comments
Assessment date
Principal references
399
the body. Nitrate metabolism is different in humans and rats, as rats may not actively
secrete nitrate in their saliva.
Nitrate probably has a role in protecting the gastrointestinal tract against a variety
of gastrointestinal pathogens, as nitrous oxide and acidified nitrite have antibacterial
properties. It may have other beneficial physiological roles. There may therefore be
a benefit from exogenous nitrate uptake, and there remains a need to balance the
potential risks with the potential benefits.
Significant bacterial reduction of nitrate to nitrite does not normally take place
in the stomach, except in individuals with low gastric acidity or with gastrointestinal
infections. These may include individuals using antacids, particularly those that block
acid secretion.
In humans, methaemoglobinaemia is a consequence of the reaction of nitrite
with haemoglobin in the red blood cells to form methaemoglobin, which binds
oxygen tightly and does not release it, thus blocking oxygen transport. Although
most absorbed nitrite is oxidized to nitrate in the blood, residual nitrite can react
with haemoglobin. High levels of methaemoglobin (greater than 10%) formation
in infants can give rise to cyanosis, referred to as blue-baby syndrome. Although
clinically significant methaemoglobinaemia can occur as a result of extremely high
nitrate intake in adults and children, the most familiar situation is its occurrence
in bottle-fed infants. This was considered to be primarily a consequence of high
levels of nitrate in water, although there have been cases of methaemoglobinaemia
in weaned infants associated with high nitrate intake from vegetables. Bottle-fed
infants are considered to be at greater risk because the intake of water in relation to
body weight is high and, in infants, the development of repair enzymes is limited. In
clinical epidemiological studies of methaemoglobinaemia and subclinical increases
in methaemoglobin levels associated with drinking-water nitrate, 97% of cases occurred at concentrations in excess of 44.3 mg/l, with clinical symptoms associated
with the higher concentrations. The affected individuals were almost exclusively
under 3 months of age.
Although drinking-water nitrate may be an important risk factor for methaemoglobinaemia in bottle-fed infants, there is compelling evidence that the risk of
methaemoglobinaemia is primarily increased in the presence of simultaneous gastrointestinal infections, which increase endogenous nitrite formation, may increase
nitrate reduction to nitrite and may also increase the intake of water in combatting
dehydration. Cases have been described in which gastrointestinal infection seems to
have been the primary cause of methaemoglobinaemia. Most cases of methaemo
globinaemia reported in the literature are associated with contaminated private
wells that also have a high probability of microbial contamination and predominantly when the drinking-water is anaerobic, which should not occur if it is properly
disinfected.
Nitrite can react with nitrosatable compounds, primarily secondary amines, in
the body to form N-nitroso compounds. A number of these are considered to be
carcinogenic to humans, whereas others, such as N-nitrosoproline, are not. Several
studies have been carried out on the formation of N-nitroso compounds in relation
to nitrate intake in humans, but there is large variation in the intake of nitrosatable
400
The guideline value for nitrite of 3 mg/l as nitrite (or 0.9 mg/l if reported as
itrite-nitrogen) is based on human data showing that doses of nitrite that cause
n
methaemoglobinaemia in infants range from 0.4 mg/kg body weight to more than 200
mg/kg body weight. By applying the lowest level of the range (0.4 mg/kg body weight),
a body weight of 5 kg for an infant and a drinking-water consumption of 0.75 litre, a
guideline value of 3 mg/l (rounded figure) can be derived.
Because of the possibility of the simultaneous occurrence of nitrate and nitrite in
drinking-water, the sum of the ratios of the concentration (C) of each to its guideline
value (GV) should not exceed 1:
Cnitrate
GVnitrate
Cnitrite
GVnitrite
For chronic exposure, JECFA proposed an ADI of 03.7 mg/kg body weight for
nitrate and an ADI of 00.07 mg/kg body weight for nitrite, expressed as nitrite ion.
The value for nitrate is based on a NOEL of 370 mg/kg body weight per day in laboratory animal studies; in view of the known interspecies variation in nitrate/nitrite
metabolism, however, it was not considered appropriate at this time to use this in the
risk assessment for humans. The JECFA ADI for nitrite was based on effects on heart
and lung in a 2-year study in rats using a safety factor of 100. However, owing to the
uncertainty surrounding the susceptibility of humans compared with experimental
animals, this value was considered provisional and has now been suspended and is
being subjected to review in light of evidence on the differences in nitrite metabolism
between laboratory rodents and humans.
Practical considerations
The most appropriate means of controlling nitrate concentrations, particularly in
groundwater, is the prevention of contamination. This may take the form of appropriate management of agricultural practices, the careful siting of pit latrines and
septic tanks, sewer leakage control, as well as management of fertilizer and manure
application and storage of animal manures. It may also take the form of denitrification
of wastewater effluents.
Methaemoglobinaemia has most frequently been associated with private wells. It
is particularly important to ensure that septic tanks and pit latrines are not sited near
a well or where a well is to be dug and to ensure that animal manure is kept at a sufficient distance to ensure that runoff cannot enter the well or the ground near the well.
It is particularly important that the household use of manures and fertilizers on small
plots near wells should be managed with care to avoid potential contamination. The
well should be sufficiently protected to prevent runoff from entering the well. Where
there are elevated concentrations of nitrate or where inspection of the well indicated
that there are sources of nitrate close by that could be causing contamination, particularly where there are indications that microbiological quality might also be poor, a
number of actions can be taken. Water should be boiled or disinfected by an appropriate means before consumption. Where alternative supplies are available for bottle-fed
402
infants, these can be used, taking care to ensure that they are microbiologically safe.
Steps should then be taken to protect the well and ensure that sources of both nitrate
and microbial contamination are removed from the vicinity of the well.
In areas where household wells are common, health authorities may wish to take
a number of steps to ensure that nitrate contamination is not or does not become a
problem. Such steps could include targeting mothers, particularly expectant mothers,
with appropriate information about water safety, assisting with visual inspection of
wells to determine whether a problem may exist, providing testing facilities where a
problem is suspected, providing guidance on disinfecting water or where nitrate levels
are particularly high, providing bottled water from safe sources or providing advice as
to where such water can be obtained.
With regard to piped supplies, where nitrate is present, the first potential approach
to treatment of drinking-water supplies, if source substitution is not feasible, is to dilute
the contaminated water with a low-nitrate source. Where blending is not feasible, a number of treatment techniques are available for drinking-water. The first is disinfection,
which may serve to oxidize nitrite to the less toxic nitrate as well as minimize the pathogenic and non-pathogenic reducing bacterial population in the water. Nitrate removal
methods include ion exchange (normally for groundwaters) and biological denitrification (normally for surface waters). However, there are disadvantages associated with
both approaches, including the need for regeneration and disposal of spent regenerant
with ion exchange, the complexities of operation and the potential for microbial and
carbon feed contamination of the final water with biological d
enitrification.
Care should be taken with the use of chloramination for providing a residual
disinfectant in the distribution system. It is important to manage this to minimize
nitrite formation, either in the main distribution system or in the distribution systems
of buildings where chloramines are used to control Legionella.
Nitrilotriacetic acid
Nitrilotriacetic acid, or NTA, is used primarily in laundry detergents as a replacement for phosphates and in the treatment of boiler water to prevent accumulation of
mineral scale.
Guideline value
Occurrence
TDI
Limit of detection
Treatment performance
Assessment date
1993
Principal reference
NTA is not metabolized in experimental animals and is rapidly eliminated, although some may be briefly retained in bone. It is of low acute toxicity to experimental
animals, but it has been shown to produce kidney tumours in rodents following longterm exposure to doses higher than those required to produce nephrotoxicity. IARC
has placed NTA in Group 2B (possibly carcinogenic to humans). It is not genotoxic,
and the reported induction of tumours is believed to be due to cytotoxicity resulting
from the chelation of divalent cations such as zinc and calcium in the urinary tract,
leading to the development of hyperplasia and subsequently neoplasia.
Nitrobenzene
Nitrobenzene is used primarily in the production of aniline, but it is also used as a solvent, as an ingredient of metal polishes and soaps and in the synthesis of other organic
compounds, including acetaminophen. Nitrobenzene can be released to water during
these production processes.
Concentrations of nitrobenzene in environmental samples, such as surface water,
groundwater and air, are generally low, except in areas with industrial pollution.
Based on limited data, it appears that the potential for contamination is greater for
groundwater than for surface water.
The general population can be exposed to variable concentrations of nitrobenzene
in air and possibly drinking-water. Only populations in the vicinity of manufacturing
activities and petroleum refining plants are likely to have any significant exposure to
nitrobenzene; however, people living in and around abandoned hazardous waste sites
may also have potential for higher exposure, due to possible groundwater and soil
contamination and uptake of nitrobenzene by plants.
Reason for not establishing
a guideline value
Assessment date
2009
Principal reference
of spills and where there are higher concentrations in industrial areas. Two healthbased values are derived based on the limited available information: one for shortterm exposure (30 g/l) and the other for long-term exposure (863 g/l, depending
on end-point and approach used). It should be emphasized that the derivation of
the long-term health-based values includes large uncertainties because of the dose
metric conversion from inhalation studies and the possibility of increased metabolism
to aniline in the gastrointestinal tract.
It should be emphasized that nitrobenzene is a potent methaemoglobinaemic
agent in humans, which is of particular concern for bottle-fed infants. Currently, data
are not adequate to determine a separate health-based value for this end-point.
It should also be noted that the reported odour threshold for nitrobenzene in
water is 30110 g/l.
N-Nitrosodimethylamine
N-Nitrosodimethylamine, or NDMA, can occur in drinking-water through the degradation of dimethylhydrazine (a component of rocket fuel) as well as from several
other industrial processes. It is also a contaminant of certain pesticides. NDMA has
recently been identified as a disinfection by-product of chloramination (by the reaction of monochloramine with dimethylamine, a ubiquitous component of waters affected by wastewater discharges) and, to some extent, chlorination. NDMA can also be
formed as a by-product of anion exchange treatment of water.
Guideline value
Occurrence
Limit of detection
0.028 ng/l by capillary column GC and chemical ionization tandem MS; 0.4
ng/l by capillary column GC and high-resolution MS; 0.71.6 ng/l by GC-MS
and ammonia positive chemical ionization detection
Treatment performance
Additional comments
Assessment date
2006
Principal references
405
Assessment date
2003
Principal references
Parathion inhibits cholinesterase activity in all species tested. There has been no
evidence of carcinogenicity in 2-year rat studies. JMPR concluded that parathion is
not genotoxic.
A health-based value of 10 g/l can be calculated for parathion on the basis of an
ADI of 00.004 mg/kg body weight based on a NOAEL of 0.4 mg/kg body weight per
day in a 2-year study in rats for retinal atrophy and inhibition of brain acetylcholinesterase at the next higher dose, and using an uncertainty factor of 100 for interspecies
and intraspecies variation. Lower NOAELs in experimental animals, based only on
inhibition of erythrocyte or brain acetylcholinesterase, were not considered relevant
406
Occurrence
TDI
Limit of detection
Treatment performance
1993
Principal reference
Provisional guideline
value
Occurrence
Limit of detection
Assessment date
1998
Principal reference
Assessment date
2004
Principal reference
Additional comments
Assessment date
1993
Principal reference
Assessment date
2003
Principal references
roasting, frying or baking. For the general population, the major routes of exposure
to PAHs are from food and ambient and indoor air. The use of open fires for heating and cooking, which is common especially in developing countries, may increase
PAH exposure. Where there are elevated levels of contamination by coal tar coatings
of water pipes, PAH intake from drinking-water could equal or even exceed that
from food.
Guideline value
Occurrence
Limit of detection
Treatment performance
Additional comments
The presence of significant concentrations of benzo[a]pyrene in drinkingwater in the absence of very high concentrations of fluoranthene indicates
the presence of coal tar particles, which may arise from seriously deteriorating coal tar pipe linings.
It is recommended that the use of coal tarbased and similar materials
for pipe linings and coatings on storage tanks be discontinued.
Assessment date
1998
Principal reference
Reason for not establishing Fluoranthene: Occurs in drinking-water at concentrations well below
a guideline value
those of health concern
Assessment date
1998
Principal reference
411
Assessment date
2009
Principal reference
Currently, there is no evidence that potassium levels in municipally treated drinking-water, even water treated with potassium permanganate, are likely to pose any risk
for the health of consumers. It is not considered necessary to establish a health-based
guideline value for potassium in drinking-water.
Although potassium may cause some health effects in susceptible individuals, potassium intake from drinking-water is well below the level at which adverse
health effects may occur. Health concerns would be related to the consumption of
drinking-water treated by potassium-based water treatment (principally potassium
chloride for regeneration of ion exchange water softeners), affecting only individuals
in high-risk groups (i.e. individuals with kidney dysfunction or other diseases, such
as heart disease, coronary artery disease, hypertension, diabetes, adrenal insufficiency,
pre-existing hyperkalaemia; people taking medications that interfere with normal
potassium-dependent functions in the body; and older individuals or infants). It is
recommended that susceptible individuals seek medical advice to determine whether they should avoid the consumption of water (for drinking or cooking) treated by
water softeners using potassium chloride.
412
Assessment date
2003
Principal reference
Although a health-based value for propanil can be derived, this has not been
done, because propanil is readily transformed into metabolites that are more toxic.
Therefore, a guideline value for the parent compound is considered inappropriate,
and there are inadequate data on the metabolites to allow the derivation of guideline
values for them. Authorities should consider the possible presence in water of more
toxic environmental metabolites.
Selenium
Selenium is present in Earths crust, often in association with sulfur-containing minerals. Selenium is an essential trace element, and foodstuffs such as cereals, meat and
fish are the principal source of selenium for the general population. Levels in food
also vary greatly according to geographical area of production. However, even in highselenium areas, the relative contribution of selenium from drinking-water is likely to
be small in comparison with that from locally produced food.
Provisional guideline value 0.04 mg/l (40 g/l)
The guideline value is designated as provisional because of the
uncertainties inherent in the scientific database.
Occurrence
413
Limit of detection
Treatment performance
Additional comments
It is important that a proper balance be achieved between recommended intakes and undesirable intakes in determining an appropriate
guideline value for selenium in drinking-water. While for most parts
of the world, the concentration of selenium in drinking-water will not
exceed 10 g/l, there are circumstances in which selenium may be
elevated significantly above normal concentrations, and guidance may
be required. Where selenium intake from the diet is known, this should
be used in determining a concentration that ensures that intake is
safe and sufficient. Where selenium intake from the diet is not known,
guidance may be required.
For most Member States, a drinking-water guideline for selenium is
unnecessary. Where there are regions of high intake from a number of
sources, of which drinking-water may be one, then Member States should
take into consideration exposure from all sources in determining actions
to reduce exposure. For drinking-water, this may include using alternative
sources, blending low-selenium sources with high-selenium sources as
well as considering selenium removal.
Assessment date
2010
Principal references
Selenium is an essential element for humans, and there are indications that selenium status may be marginal in many parts of the world, including western Europe.
The potential for adverse effects from selenium deficiency appears to be dependent on
a number of factors, including overall health and nutritional status. Very low selenium
status in humans has been associated with a juvenile, multifocal myocarditis called
Keshan disease and a chondrodystrophy called Kaschin-Beck disease. Several studies
have also found blood selenium levels to be inversely associated with the prevalence
of several types of cancer.
High intakes of selenium are also associated with a number of specific diseases
and the potential for adverse effects, but, again, this seems to be strongly influenced by
other factors. Symptoms in people with high urinary selenium levels included gastrointestinal disturbances, discoloration of the skin, decayed teeth, hair or nail loss, nail
abnormalities and changes in peripheral nerves. Slight biochemical changes have also
been observed. One case of selenium toxicity directly attributable to a water source
(well water containing selenium at a concentration of 9 mg/l) has been reported. The
414
average dietary intake that is associated with selenosis has been found to be in excess
of 900 g/day.
As selenium is an essential element, various national and international organizations have established recommended daily intakes of selenium. A joint FAO/WHO
consultation recommended intakes of 621 g of selenium per day for infants and
children, according to age, 26 and 30 g of selenium per day for adolescent females
and males, respectively, and 26 and 35 g of selenium per day for adult females and
males, respectively.
Because of concern about the adverse effects resulting from exposure to excessive
levels of selenium, various national and international organizations have established
upper limits of exposure for selenium. FAO/WHO established an upper tolerable limit
for selenium of 400 g/day.
Silver
Silver occurs naturally, mainly in the form of its very insoluble and immobile oxides,
sulfides and some salts. It has occasionally been found in groundwater, surface water
and drinking-water at concentrations above 5 g/l. Levels in drinking-water treated
with silver for disinfection may be above 50 g/l. Recent estimates of daily intake are
about 7 g per person.
Reason for not establishing
a guideline value
Assessment date
1993
Principal reference
Guideline value
Occurrence
TDI
0.52 g/kg body weight, based on a NOAEL of 0.52 mg/kg body weight
from a long-term study in the rat (based on weight changes, effects
on haematological parameters and an increase in mammary tumours)
and an uncertainty factor of 1000 (100 for interspecies and intraspecies
variation and 10 for possible non-genotoxic carcinogenicity)
Limit of detection
Treatment performance
allocation to water
weight
consumption
10% of TDI
60 kg adult
2 litres/day
Assessment date
1993
Principal reference
Additional comments
Assessment date
1993
Principal reference
416
Sodium dichloroisocyanurate
Sodium dichloroisocyanurate is the sodium salt of a chlorinated hydroxytriazine and
is used as a source of free available chlorine, in the form of hypochlorous acid, for the
disinfection of water. It is widely used as a stable source of chlorine for the disinfection
of swimming pools and in the food industry. It is also used as a means of disinfecting
drinking-water, primarily in emergencies, when it provides an easy-to-use source of
free chlorine, and, more recently, as the form of chlorine for household point-of-use
water treatment.
Guideline values
Occurrence
TDI
Limit of detection
Treatment performance
The controlling factors are the level of free chlorine and the residue of
cyanuric acid, particularly if there is topping up of chlorine in a static
system under emergency conditions. The concentration of free chlorine
should normally be such that it should not give rise to unacceptable
tastes and should not normally exceed the guideline value of 5 mg/l for
free chlorine.
Sodium dichloroisocyanurate used for disinfecting drinking-water should
be of adequate purity so that there is no increase in any inorganic or
organic contaminants in the drinking-water. The amounts of sodium
dichloroisocyanurate used should be the lowest consistent with
adequate disinfection, and the concentrations of cyanuric acid should be
managed to be kept as low as is reasonably possible.
417
Assessment date
2007
Principal references
Studies of the toxicity of sodium cyanurate are appropriate for assessing the safety
of sodium dichloroisocyanurate, because any residues of intact sodium dichloroisocyanurate in drinking-water would be rapidly converted to cyanuric acid on contact with
saliva. Both sodium dichloroisocyanurate and sodium cyanurate have low acute oral
toxicity. Sodium cyanurate does not induce any genotoxic, carcinogenic or teratogenic
effects. The NOEL from which the guideline value was derived was based on multiple
lesions of the urinary tract (calculi and hyperplasia, bleeding and inflammation of the
bladder epithelium, dilated and inflamed ureters and renal tubular nephrosis) and
cardiac lesions (acute myocarditis, necrosis and vascular mineralization) in male rats
exposed at the next higher dose.
Styrene
Styrene, which is used primarily for the production of plastics and resins, is found in
trace amounts in surface water, drinking-water and food. In industrial areas, exposure via air can result in intake of a few hundred micrograms per day. Smoking may
increase daily exposure by up to 10-fold.
Guideline value
Occurrence
TDI
7.7 g/kg body weight, based on a NOAEL of 7.7 mg/kg body weight per
day for decreased body weight observed in a 2-year drinking-water study
in rats, and using an uncertainty factor of 1000 (100 for interspecies and
intraspecies variation and 10 for the carcinogenicity and genotoxicity of
the reactive intermediate styrene-7,8-oxide)
Limit of detection
Treatment performance
10% of TDI
60 kg adult
2 litres/day
Additional comments
Assessment date
1993
Principal reference
has a low acute toxicity. In short-term toxicity studies in rats, impairment of glutathione transferase activity and reduced glutathione concentrations were observed. In in
vitro tests, styrene has been shown to be mutagenic in the presence of metabolic activation only. In in vitro as well as in vivo studies, chromosomal aberrations have been
observed, mostly at high doses of styrene. The reactive intermediate styrene-7,8-oxide
is a direct-acting mutagen. In long-term studies, orally administered styrene increased
the incidence of lung tumours in mice at high dose levels but had no carcinogenic effect
in rats. Styrene-7,8-oxide was carcinogenic in rats after oral administration. IARC has
classified styrene in Group 2B (possibly carcinogenic to humans). The available data
suggest that the carcinogenicity of styrene is due to overloading of the detoxification
mechanism for styrene-7,8-oxide (e.g. glutathione depletion).
Sulfate
Sulfates occur naturally in numerous minerals and are used commercially, principally in the chemical industry. They are discharged into water in industrial wastes and
through atmospheric deposition; however, the highest levels usually occur in groundwater and are from natural sources. In general, the average daily intake of sulfate from
drinking-water, air and food is approximately 500 mg, food being the major source.
However, in areas with drinking-water supplies containing high levels of sulfate,
drinking-water may constitute the principal source of intake.
Reason for not establishing
a guideline value
Additional comments
Assessment date
2003
Principal reference
The existing data do not identify a level of sulfate in drinking-water that is likely to
cause adverse human health effects. The data from a liquid diet study with piglets and
from tap water studies with human volunteers indicate a laxative effect at concentrations
of 10001200 mg/l, but no increase in diarrhoea, dehydration or weight loss.
No health-based guideline is proposed for sulfate. However, because of the gastrointestinal effects resulting from ingestion of drinking-water containing high sulfate
levels, it is recommended that health authorities be notified of sources of drinkingwater that contain sulfate concentrations in excess of 500 mg/l. The presence of sulfate
in drinking-water may also cause noticeable taste (see chapter 10) and may contribute
to the corrosion of distribution systems.
2,4,5-T
The half-lives for degradation of chlorophenoxy herbicides, including 2,4,5-T (CAS
No. 93-76-5), also known as 2,4,5-trichlorophenoxyacetic acid, in the environment
are in the order of several days. Chlorophenoxy herbicides are not often found in
food.
419
Guideline value
Occurrence
TDI
Limit of detection
Treatment performance
1993
Principal reference
Chlorophenoxy herbicides, as a group, have been classified in Group 2B (possibly carcinogenic to humans) by IARC. However, the available data from studies in
exposed populations and experimental animals do not permit assessment of the carcinogenic potential to humans of any specific chlorophenoxy herbicide. Therefore,
drinking-water guidelines for these compounds are based on a threshold approach
for other toxic effects. The NOAEL for reproductive effects (reduced neonatal survival, decreased fertility, reduced relative liver weights and thymus weights in litters)
of dioxin-free (<0.03 g/kg) 2,4,5-T in a three-generation reproduction study in rats
is the same as the NOAEL for reduced body weight gain, increased liver and kidney
weights and renal toxicity in a toxicity study in which rats were fed 2,4,5-T (practically
free from dioxin contamination) in the diet for 2 years.
Terbuthylazine
Terbuthylazine (CAS No. 5915-41-3), or TBA, a herbicide that belongs to the chlorotriazine family, is used in both pre-emergence and post-emergence treatment of a
variety of agricultural crops and in forestry. Degradation of TBA in natural water
depends on the presence of sediments and biological activity.
Guideline value
Occurrence
TDI
2.2 g/kg body weight, based on a NOAEL of 0.22 mg/kg body weight for
decreased body weight gain at the next higher dose in a 2-year toxicity/
carcinogenicity study in rats, with an uncertainty factor of 100 (for
interspecies and intraspecies variation)
420
Limit of detection
Treatment performance
1998
Principal reference
Occurrence
TDI
Limit of detection
Treatment performance
allocation to water
weight
consumption
10% of TDI
60 kg adult
2 litres/day
Assessment date
1993
Principal reference
421
At high concentrations, tetrachloroethene causes central nervous system depression. Lower concentrations of tetrachloroethene have been reported to damage the
liver and the kidneys. IARC has classified tetrachloroethene in Group 2A (probably
carcinogenic to humans). Tetrachloroethene has been reported to produce liver tumours in male and female mice, with some evidence of mononuclear cell leukaemia
in male and female rats and kidney tumours in male rats. The overall evidence from
studies conducted to assess the genotoxicity of tetrachloroethene, including induction
of single-strand DNA breaks, mutation in germ cells and chromosomal aberrations in
vitro and in vivo, indicates that tetrachloroethene is not genotoxic.
Toluene
Most toluene (in the form of benzenetolueneethylbenzenexylene mixtures) is used
in the blending of petrol. It is also used as a solvent and as a raw material in chemical
production. The main exposure is via air. Exposure is increased by smoking and in
traffic.
Guideline value
Occurrence
TDI
223 g/kg body weight, based on a LOAEL of 312 mg/kg body weight per
day for marginal hepatotoxic effects observed in a 13-week gavage study in
mice, adjusting for daily dosing and using an uncertainty factor of 1000 (100
for interspecies and intraspecies variation and 10 for the short duration of
the study and use of a LOAEL instead of a NOAEL)
Limit of detection
Treatment performance
The guideline value exceeds the lowest reported odour threshold for
toluene in water.
Assessment date
2003
Principal reference
Toluene is absorbed completely from the gastrointestinal tract and rapidly distributed in the body, with a preference for adipose tissue. Toluene is rapidly metabolized and, following conjugation, excreted predominantly in urine. With occupational
exposure to toluene by inhalation, impairment of the central nervous system and irritation of mucous membranes are observed. The acute oral toxicity is low. Toluene
exerts embryotoxic and fetotoxic effects, but there is no clear evidence of teratogenic
activity in laboratory animals and humans. In long-term inhalation studies in rats
422
Additional comments
Assessment date
1993
Principal reference
Reliable data on possible health effects associated with the ingestion of TDS in
drinking-water are not available, and no health-based guideline value is proposed.
However, the presence of high levels of TDS in drinking-water may be objectionable
to consumers (see chapter 10).
Trichloroacetic acid
Chlorinated acetic acids are formed from organic material during water chlorination.
Guideline value
Occurrence
TDI
32.5 g/kg body weight, based on a NOAEL of 32.5 mg/kg body weight
per day from a study in which decreased body weight, increased liver
serum enzyme activity and liver histopathology were seen in rats
exposed to trichloroacetate in drinking-water for 2 years, incorporating
an uncertainty factor of 1000 (100 for interspecies and intraspecies
variation and 10 for database deficiencies, including the absence of a
multigeneration reproductive study, the lack of a developmental study
in a second species and the absence of full histopathological data in a
second species)
Limit of detection
423
Treatment performance
Assessment date
2003
Principal reference
Trichloroacetic acid has been shown to induce tumours in the liver of mice. It has
given mixed results in in vitro assays for mutations and chromosomal aberrations and
has been reported to cause chromosomal aberrations in in vivo studies. IARC has classified trichloroacetic acid in Group 3, not classifiable as to its carcinogenicity to humans.
The weight of evidence indicates that trichloroacetic acid is not a genotoxic carcinogen.
Trichlorobenzenes (total)
Releases of trichlorobenzenes (TCBs) into the environment occur through their
manufacture and use as industrial chemicals, chemical intermediates and solvents.
TCBs are found in drinking-water, but rarely at levels above 1 g/l. General population
exposure will primarily result from air and food.
Reason for not establishing
a guideline value
Assessment date
2003
Principal reference
The TCBs are of moderate acute toxicity. After short-term oral exposure, all three
isomers show similar toxic effects, predominantly on the liver. Long-term toxicity
and carcinogenicity studies via the oral route have not been carried out, but the data
available suggest that all three isomers are non-genotoxic.
A health-based value of 20 g/l can be calculated for total TCBs on the basis of a
TDI of 7.7 g/kg body weight, based on liver toxicity identified in a 13-week rat study,
taking into consideration the short duration of the study. However, because TCBs
occur at concentrations well below those of health concern, it is not considered necessary to derive a formal guideline value. It should be noted that the health-based value
exceeds the lowest reported odour threshold in water.
1,1,1-Trichloroethane
1,1,1-Trichloroethane is widely used as a cleaning solvent for electrical equipment, as
a solvent for adhesives, coatings and textile dyes and as a coolant and lubricant. It is
424
found mainly in the atmosphere, although it is mobile in soils and readily migrates
to groundwaters. 1,1,1-Trichloroethane has been found in only a small proportion of
surface waters and groundwaters, usually at concentrations of less than 20 g/l; higher
concentrations (up to 150 g/l) have been observed in a few instances. There appears
to be increasing exposure to 1,1,1-trichloroethane from other sources.
Reason for not establishing
a guideline value
Assessment date
2003
Principal reference
Owing to its high volatility, concentrations are normally low (<1 g/l)
in surface water; concentrations may be higher (usually below 100
g/l) in groundwater systems where volatilization and biodegradation
are limited
TDI
1.46 g/kg body weight per day in a developmental toxicity study in rats,
based on a BMDL10 (the lower 95% confidence limit corresponding to a
10% increase in extra risk of fetal heart malformations over background)
of 0.146 mg/kg body weight per day and using an uncertainty factor of
100 for intraspecies and interspecies variation
425
Limit of detection
Treatment performance
50% of TDI
60 kg adult
2 litres/day
The guideline value is protective for both cancer and non-cancer endpoints.
In countries with low rates of ventilation in houses and high rates of
showering and bathing, authorities may wish to take the additional
exposures through the dermal and inhalation routes into consideration
in developing national standards from the provisional guideline value.
Assessment date
2004
Principal reference
Occurrence
TDI
7.5 g/kg body weight, based on a NOAEL of 0.75 mg/kg body weight for
mild hepatic effects in a 1year feeding study in dogs, with an uncertainty
factor of 100 (for interspecies and intraspecies variation)
Limit of detection
426
Treatment performance
Assessment date
1993
Principal reference
427
Occurrence
THMs are not expected to be found in raw water (unless near a pollution
source), but are usually present in finished or chlorinated water;
concentrations are generally below 100 g/l; in most circumstances,
chloroform is the dominant compound
TDIs
Limit of detection
Treatment performance
CDBCM
GVDBCM
CBDCM
GVBDCM
Cchloroform
GVchloroform
428
Additional comments on
chloroform
Additional comments on
BDCM
Assessment date
2004
Principal references
Chloroform
The weight of evidence for genotoxicity of chloroform is considered negative. IARC
has classified chloroform as possibly carcinogenic to humans (Group 2B) based on
limited evidence of carcinogenicity in humans but sufficient evidence of carcinogenicity in experimental animals. The weight of evidence for liver tumours in mice is consistent with a threshold mechanism of induction. Although it is plausible that kidney
tumours in rats may similarly be associated with a threshold mechanism, there are
some limitations of the database in this regard. The most universally observed toxic
effect of chloroform is damage to the centrilobular region of the liver. The severity of
these effects per unit dose administered depends on the species, vehicle and method
by which the chloroform is administered.
Bromoform
In an NTP bioassay, bromoform induced a small increase in relatively rare tumours of
the large intestine in rats of both sexes but did not induce tumours in mice. Data from
429
a variety of assays on the genotoxicity of bromoform are equivocal. IARC has classified
bromoform in Group 3 (not classifiable as to its carcinogenicity to humans).
Dibromochloromethane
In an NTP bioassay, DBCM induced hepatic tumours in female mice and possibly in
male mice but not in rats. The genotoxicity of DBCM has been studied in a number of
assays, but the available data are considered inconclusive. IARC has classified DBCM
in Group 3 (not classifiable as to its carcinogenicity to humans).
Bromodichloromethane
IARC has classified BDCM in Group 2B (possibly carcinogenic to humans). BDCM
gave both positive and negative results in a variety of in vitro and in vivo genotoxicity
assays. In an NTP bioassay, BDCM induced renal adenomas and adenocarcinomas in
both sexes of rats and male mice, rare tumours of the large intestine (adenomatous
polyps and adenocarcinomas) in both sexes of rats and hepatocellular adenomas and
adenocarcinomas in female mice. However, BDCM was negative for carcinogenicity
in a recent NTP bioassay in which it was dosed in drinking-water. Exposure to BDCM
has also been linked to a possible increase in reproductive effects (increased risk for
spontaneous abortion or stillbirth).
Uranium
Uranium is widespread in nature, occurring in granites and various other mineral
deposits. It is used mainly as fuel in nuclear power stations. Uranium is present in
the environment as a result of leaching from natural deposits, release in mill tailings,
emissions from the nuclear industry, the combustion of coal and other fuels and the
use of phosphate fertilizers that contain uranium. Intake of uranium through air is
low, and it appears that intake through food is between 1 and 4 g/day. Intake through
drinking-water is normally extremely low; however, in circumstances in which uranium is present in a drinking-water source, the majority of intake can be through
drinking-water.
Provisional guideline value 0.03 mg/l (30 g/l)
The guideline value is designated as provisional because of scientific
uncertainties surrounding uranium toxicity.
Occurrence
TDI
Limit of detection
0.01 g/l by ICP-MS; 0.1 g/l by solid fluorimetry with either laser
excitation or UV light; 0.2 g/l by ICP using adsorption with chelating
resin
Treatment performance
430
2 litres/day
Additional comments
Assessment date
Principal reference
Guideline value
Occurrence
Limit of detection
The results of the linear extrapolation are nearly identical to those derived
using the linearized multistage model.
As vinyl chloride is a known human carcinogen, exposure to this compound
should be avoided as far as practicable, and levels should be kept as low as
technically feasible.
Vinyl chloride is primarily of concern as a potential contaminant from
some grades of PVC pipe and is best controlled by specification of
material q
uality.
Assessment date
2003
Principal references
432
Guideline value
Occurrence
TDI
179 g/kg body weight, based on a NOAEL of 250 mg/kg body weight
per day for decreased body weight in a 103-week gavage study in rats,
adjusting for daily dosing and using an uncertainty factor of 1000 (100 for
interspecies and intraspecies variation and 10 for the limited toxicological
end-points)
Limit of detection
Treatment performance
The guideline value exceeds the lowest reported odour threshold for
xylenes in drinking-water.
Assessment date
1993
Principal reference
Xylenes are rapidly absorbed by inhalation. Data on oral exposure are lacking.
Xylenes are rapidly distributed in the body, predominantly in adipose tissue. They
are almost completely metabolized and excreted in urine. The acute oral toxicity of
xylenes is low. No convincing evidence for teratogenicity has been found. Long-term
carcinogenicity studies have shown no evidence for carcinogenicity. In vitro as well as
in vivo mutagenicity tests have proved negative.
Zinc
Zinc is an essential trace element found in virtually all food and potable water in the
form of salts or organic complexes. The diet is normally the principal source of zinc.
Although levels of zinc in surface water and groundwater normally do not exceed 0.01
and 0.05 mg/l, respectively, concentrations in tap water can be much higher as a result
of dissolution of zinc from pipes.
Reason for not establishing
a guideline value
Additional comments
Assessment date
1993
Principal reference
In 1982, JECFA proposed a PMTDI for zinc of 1 mg/kg body weight. The daily requirement for adult men is 1520 mg/day. It was considered that, taking into account
433
recent studies on humans, the derivation of a formal guideline value is not required at
this time. However, drinking-water containing zinc at levels above 3 mg/l may not be
acceptable to consumers (see chapter 10).
Assessment date
2009
Principal references
Preparations of Bti are widely used against mosquitoes, chironomids and blackflies, and this specific activity against disease vector species has resulted in the use of
434
Bti in water. Bti is recommended under WHOPES for use in vector control, including
against container-breeding mosquitoes, and can be used in drinking-water that will receive little or no further treatment for control of Aedes aegypti. It is essential that Bti for
larvicidal use be prepared under carefully controlled conditions and properly assayed
before use for evidence of potency, for excessive levels of expressed Bti constituents or
metabolites that are toxic and for contamination by other undesirable microbes.
Bti itself is not considered to pose a hazard to humans through drinking-water.
Therefore, it is not considered necessary or appropriate to establish a health-based
value for its use for controlling vector larvae in drinking-water. However, it is vital that
authorities can be assured that Bti has been prepared to the highest quality and hygienic standards under appropriate conditions that will meet the WHOPES specifications. It is important that the possible risks are set against the risks from vector-borne
diseases such as dengue fever.
Application should be carried out by trained applicators and Bti used in conjunction with other approaches to vector control, including exclusion of mosquitoes from
containers and other control options.
Diflubenzuron
Diflubenzuron is a direct-acting insecticide normally applied directly to plants or
water. It is used in public health applications against mosquito and noxious fly larvae. WHO is considering diflubenzuron for use as a mosquito larvicide in drinkingwater in containers, particularly to control dengue fever. The recommended dosage
of diflubenzuron in potable water in containers should not exceed 0.25 mg/l under
WHOPES.
It is reported that public exposure to diflubenzuron through either food or
drinking-water is negligible. However, there is a potential for direct exposure through
drinking-water when diflubenzuron is directly applied to drinking-water storage
containers.
Reason for not establishing
a guideline value
Assessment date
2007
Principal references
The ADI determined by JMPR in 2001 was 00.02 mg/kg body weight. The maximum
dosage in drinking-water of 0.25 mg/l would be equivalent to approximately 40%
of the upper limit of the ADI allocated to drinking-water for a 60 kg adult drinking
2litres of water per day. For a 10 kg child drinking 1 litre of water, the exposure would
be 0.25 mg, compared with an exposure of 0.2mg at the upper limit of the ADI. For
a 5 kg bottle-fed infant drinking 0.75 litre per day, the exposure would be 0.19 mg,
compared with an exposure of 0.1 mg at the upper limit of the ADI. Diflubenzuron is
unlikely to remain in solution at the maximum recommended applied dose, and the
actual levels of exposure are likely to be much lower than those calculated.
Consideration should be given to using alternative sources of water for bottlefed infants for a period after an application of diflubenzuron, where this is practical.
However, exceeding the ADI will not necessarily result in adverse effects.
Methoprene
WHO has assessed methoprene for use as a mosquito larvicide in drinking-water in containers, particularly to control dengue fever. The recommended dosage of methoprene
in potable water in containers should not exceed 1 mg/l under WHOPES.
Reason for not establishing
a guideline value
Assessment date
2007
Principal references
In 2001, JMPR reaffirmed the basis of the ADI for racemic methoprene established in 1987, but lowered the value to 00.09 mg/kg body weight to correct for the
purity of the racemate tested. The basis for the ADI was the NOAEL of 500 mg/kg
diet, equivalent to 8.6 mg/kg body weight per day (corrected for purity), in a 90-day
study in dogs (the main effect was increased relative liver weight) and a safety factor
of 100. Young animals do not appear to be significantly more sensitive than adults.
As no bridging studies with repeated doses were available for (S)-methoprene,
JMPR made the conservative assumption that, in the absence of any information to
the contrary, all the toxicity of the racemate was due to the S enantiomer. On this
basis, JMPR established an ADI for (S)-methoprene of 00.05 mg/kg body weight,
equal to one half the ADI for the racemate (which is a 1:1 mixture of the R and S
enantiomers).
It is not considered appropriate to set a formal guideline value for methoprene
used as a vector control agent in drinking-water. Where methoprene is used for vector
control in potable water, this will involve less than lifetime exposure. The maximum
dosage in drinking-water of 1 mg/l would be equivalent to approximately 66% of the
upper limit of the ADI (0.033 mg/kg body weight) for a 60 kg adult drinking 2 litres
of water per day. The exposure for a 10 kg child drinking 1 litre of water would be
approximately 0.1 mg/kg body weight, and for a 5 kg bottle-fed infant, the exposure
436
would be approximately 0.15 mg/kg body weight, compared with the upper limit of
the ADI of 0.05 mg/kg body weight. However, the low solubility and the high log
octanolwater partition coefficient of methoprene indicate that it is unlikely to remain in solution at the maximum recommended applied dose, and the actual levels
of exposure are likely to be much lower than those calculated. Exposure from food is
considered to be low.
Consideration should be given to using alternative sources of water for small
children and bottle-fed infants for a period after an application of methoprene,
where this is practical. However, exceeding the ADI will not necessarily result in adverse effects.
Novaluron
Novaluron has been registered as an insecticide for food crops and ornamentals in a
number of countries. WHO has assessed novaluron for use as a mosquito larvicide in
drinking-water in containers, particularly to control dengue fever. The recommended
dosage of novaluron in potable water in containers should not exceed 0.05 mg/l under
WHOPES.
Reason for not establishing
a guideline value
Assessment date
2007
Principal references
In view of the absence of a carcinogenic potential in rodents and the lack of genotoxic potential in vitro and in vivo, JMPR concluded that novaluron is unlikely to
pose a carcinogenic risk to humans. JMPR also concluded that novaluron is not a
developmental toxicant. JMPR established an ADI of 00.01mg/kg body weight on
the basis of the NOAEL of 1.1mg/kg body weight per day for erythrocyte damage and
secondary splenic and liver changes in a 2-year dietary study in rats, using a safety
factor of 100.
It is not considered appropriate to set a formal guideline value for novaluron
as a vector control agent in drinking-water. At the maximum recommended dosage
for drinking-water of 0.05 mg/l, the intake of a 60 kg adult drinking 2 litres of water
would represent only 17% of the upper limit of the ADI. Similarly, the intake for a
10 kg child drinking 1 litre of water would be 50% of the upper limit of the ADI,
whereas a 5 kg bottle-fed infant drinking 0.75 litre of water would receive an intake of
75% of the upper limit of the ADI.
The high log octanolwater partition coefficient of 4.3 indicates that novaluron
is likely to adsorb to the sides of containers, and so the actual concentration is likely
to be less than the recommended dose. Exposure to novaluron through food is not
expected to be significant.
437
Permethrin
Permethrin (CAS No. 52645-53-1) is a contact insecticide effective against a broad
range of pests in agriculture, forestry and public health. It has been used as a larvicide
to control aquatic invertebrates in water mains. Permethrin is photodegraded both
in water and on soil surfaces. In soil, permethrin is rapidly degraded by hydrolysis
and microbial action under aerobic conditions. Exposure of the general population to
permethrin is mainly via the diet.
Reason for not establishing
a guideline value
Assessment date
2011
Principal references
438
Assessment date
2007
Principal references
439
Assessment date
2007
Principal references
JMPR evaluated pyriproxyfen and concluded that it was not genotoxic and does
not pose a carcinogenic risk to humans. Young animals do not appear to be significantly
more sensitive than adults.
JMPR established an ADI of 00.1 mg/kg body weight on the basis of an overall
NOAEL of 10 mg/kg body weight per day, based on increased relative liver weight and
increased total plasma cholesterol concentration in male dogs in two 1-year studies of
toxicity and using a safety factor of 100.
It is not considered appropriate to set a formal guideline value for pyriproxyfen
used for vector control in drinking-water. The maximum recommended dosage in
drinking-water of 0.01 mg/l would be equivalent to less than 1% of the upper limit
of the ADI allocated to drinking-water for a 60 kg adult drinking 2 litres of water per
day. For a 10 kg child drinking 1 litre of water, the exposure would be 0.01 mg, compared with an exposure of 1 mg at the upper limit of the ADI. For a 5 kg bottle-fed
infant drinking 0.75 litre per day, the exposure would be 0.0075 mg, compared with
an exposure of 0.5 mg at the upper limit of the ADI. The low solubility and the high
log octanolwater partition coefficient of pyriproxyfen indicate that it is unlikely to
remain in solution at the maximum recommended applied dose, and the actual levels
of exposure are likely to be even lower than those calculated.
Spinosad
Spinosad is a natural product derived from the bacterium Saccharopolyspora spinosa.
Spinosad DT is a mixture of spinosyn A and spinosyn D. It is used for mosquito
control in potable water in containers.
Spinosad DT 7.48% is specified for use as a vector control agent in drinking-water
sources against Aedes aegypti by WHO under WHOPES. Formulations for control of
vectors are specified by WHO at a dose of 0.250.5 mg/l. The expected duration of
efficacy under field conditions is 46 weeks.
Three formulations of spinosad have been evaluated by WHOPES for mosquito
larviciding. WHO specifications for quality control and international trade have been
published for the three formulations: i.e. spinosad granules (636/GR), aqueous suspension concentrate (636/SC) and tablets for direct application (636/DT). Only the
tablet formulation is used for mosquito larviciding in potable water at the dosage of
0.250.5 mg/l of the active ingredient.
In a 14-day study conducted by the manufacturer, a single tablet was added to a
200-litre container of water, and 10% of the water in this container was replenished
each day of the study. The concentration of spinosad was found to be in the range
26.551.7 g/l.
440
Assessment date
2009
Principal references
It is not appropriate to set a formal guideline value for spinosad DT for use to
control vectors breeding in drinking-water containers; however, it is appropriate to
compare the probable intakes with the ADI of 00.02 mg/kg body weight, with no
acute reference dose set because of its low acute toxicity. The maximum concentration
actually achieved with the slow-release formulation was approximately 52 g/l. The
intake would therefore be:
Assessment date
2009
Principal references
The NOAEL for human risk assessment for temephos is 2.3 mg/kg body weight
per day on the basis of inhibition of brain acetylcholinesterase activity in rats, as
determined by JMPR in 2006. Although JMPR considered that the database was
441
i nsufficiently robust to serve as the basis for establishing an ADI, for the purposes
of these Guidelines, a TDI of 0.023 mg/kg body weight can be calculated from this
NOAEL, using an uncertainty factor of 100. Young animals do not appear to be significantly more sensitive than adults, and exposure from food is considered to be low.
It is not appropriate to set a formal guideline value for temephos used as a vector
control agent in drinking-water. Where temephos is used for vector control in potable
water, this will involve less than lifetime exposure. The maximum dosage in drinkingwater of 1mg/l for a 60 kg adult drinking 2 litres of water per day would be equivalent
to approximately 0.033 mg/kg body weight, compared with the TDI of 0.023 mg/kg
body weight. The exposure for a 10 kg child drinking 1 litre of water would be approximately 0.1 mg/kg body weight; for a 5 kg bottle-fed infant, the exposure would
be approximately 0.15 mg/kg body weight, compared with the TDI of 0.023 mg/kg
body weight.
Consideration should be given to using alternative sources of water for small children and bottle-fed infants for a period after an application of temephos, where this
is practical.
However, exceeding the TDI does not necessarily mean that this will result in
adverse effects. Indeed, the low solubility and the high log octanolwater partition coefficient of temephos indicate that it is unlikely to remain in solution at the maximum
recommended applied dose, and the use of the slow-release formulation should result
in very much lower concentrations than the approved dose of 1 mg/l and actual exposures much lower than the theoretical exposures calculated above.
442
ANNEX 1
443
444
A discussion paper on the concepts and methodology of disability-adjusted life years (DALYs)
as a common public health metric and its usefulness for drinking-water quality.
http://www.who.int/entity/water_sanitation_health/dwq/rivmrep.pdf
Rapid assessment of drinking-water quality: A handbook for implementation
Published in 2011 by the World Health Organization and the United Nations Childrens
Fund
A practical guide to rapidly monitor water quality and safety, incorporating statistical
methods, sanitary survey, and field approaches.
http://www.who.int/entity/water_sanitation_health and http://www.wssinfo.org
Review of latest available evidence on potential transmission of avian influenza (H5N1) through
water and sewage and ways to reduce the risks to human health
Published in 2006 by the World Health Organization
A summary of the latest available studies and findings on avian influenza (H5N1) pertaining to water resources, water supplies, sanitation (human excreta, sewerage systems
and health-care waste) and hygiene.
http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf
Risk assessment of Cryptosporidium in drinking water
G. Medema et al.
Published in 2009 by the World Health Organization
A text supporting the Guidelines for drinking-water quality by providing further data on
Cryptosporidium to assist country authorities in setting health-based targets and water
suppliers in determining required performance of water treatment processes as part of
a system-specific water safety plan.
http://whqlibdoc.who.int/hq/2009/WHO_HSE_WSH_09.04_eng.pdf
Safe drinking-water from desalination
Published in 2011 by the World Health Organization
Highlights the principal health risks related to different desalination processes and provides guidance on appropriate risk assessment and risk management procedures in
order to ensure the safety of desalinated drinking-water.
http://www.who.int/water_sanitation_health/publications/en/index.html
Safe piped water: Managing microbial water quality in piped distribution systems
Edited by R. Ainsworth
Published in 2004 by IWA Publishing on behalf of the World Health Organization
A report on microbial contaminants and growth of microorganisms in distribution networks and the practices that contribute to ensuring drinking-water safety in piped
distribution systems.
http://www.who.int/entity/water_sanitation_health/dwq/en/safepipedwater.pdf
Scaling up household water treatment among low-income populations
T. Clasen
Published in 2009 by the World Health Organization
Examines the evidence to date regarding the scalability of household water treatment systems. Its primary aims are to review the development and evolution of leading household water treatment technologies in their efforts to achieve scale, identify the main
constraints that they have encountered and recommend ways forward.
http://whqlibdoc.who.int/hq/2009/WHO_HSE_WSH_09.02_eng.pdf
446
Toxic cyanobacteria in water: A guide to their public health consequences, monitoring and management
Edited by I. Chorus and J. Bartram
Published in 1999 by E & FN Spon on behalf of the World Health Organization
A report on all aspects of risk management, detailing the information needed for protecting drinking-water sources and recreational water bodies from the health hazards
caused by cyanobacteria and their toxins.
http://www.who.int/entity/water_sanitation_health/resourcesquality/toxcyanobacteria.
pdf
Upgrading water treatment plants
E.G. Wagner and R.G. Pinheiro
Published in 2001 by Spon Press on behalf of the World Health Organization
A practical guide to improving the performance of water treatment plants.
http://www.who.int/water_sanitation_health/hygiene/om/treatplants/en/
Water qualityGuidelines, standards and health: Assessment of risk and risk management for
water-related infectious disease
Edited by L. Fewtrell and J. Bartram
Published in 2001 by IWA Publishing on behalf of the World Health Organization
Guidance on issues relating to microbial water quality and health, including environmental and public health scientists, water scientists, policy-makers and those responsible for
developing standards and regulations.
http://www.who.int/water_sanitation_health/dwq/whoiwa/en/index.html
Water safety in buildings
Edited by D. Cunliffe et al.
Provides guidance for managing water supplies in buildings (e.g. hospitals, schools, care
facilities, hotels) where people may drink water; use water for food preparation; wash,
shower, swim or use water for other recreational activities; or be exposed to aerosols
produced by water-using devices, such as cooling towers.
http://www.who.int/water_sanitation_health/publications/2011/9789241548106/en/
index.html
Water safety plan manual: Step-by-step risk management for drinking-water suppliers
J. Bartram et al.
Published in 2009 by the World Health Organization
Guidance on developing and implementing a water safety plan through 11 learning modules, each representing a key step in the water safety plan development and implementation process.
http://whqlibdoc.who.int/publications/2009/9789241562638_eng.pdf
Water safety planning for small community water supplies
Published in 2011 by the World Health Organization
Step-by-step guidance for the planning, design and implementation of water safety plans
by and for rural and remote communities, including communities with piped schemes,
those served by point sources and community-wide water supply services using various
technical options.
http://www.who.int/water_sanitation_health/publications/en/index.html
Water safety plans: Managing drinking-water quality from catchment to consumer
A. Davison et al.
Published in 2005 by the World Health Organization
447
Guidance on improved strategies for the preventive management, control and monitoring
of drinking-water quality.
http://www.who.int/entity/water_sanitation_health/dwq/wsp170805.pdf
Water treatment and pathogen control: Process efficiency in achieving safe drinking-water
M.W. LeChevallier and K.K. Au
Published in 2004 by IWA Publishing on behalf of the World Health Organization
A critical analysis of the removal and inactivation of pathogenic microbes in water to aid
the water quality specialist and design engineer in making decisions regarding microbial water quality.
http://www.who.int/entity/water_sanitation_health/dwq/en/watreatpath.pdf
Waterborne zoonoses: Identification, causes and control
Edited by J.A. Cotruvo et al.
Published in 2004 by IWA Publishing on behalf of the World Health Organization
An invaluable tool for all professionals concerned with assessing and managing waterborne zoonoses, which are diseases caused by microorganisms of animal origin that
also infect humans.
http://www.who.int/entity/water_sanitation_health/diseases/zoonoses.pdf
448
ANNEX 2
References cited1,2
Chapter 1
Brikk F (2000) Operation and maintenance of rural water supply and sanitation systems: a
training package for managers and planners. Delft, IRC International Water and Sanitation
Centre; and Geneva, World Health Organization (http://www.who.int/water_sanitation_
health/hygiene/om/omruralsystems/en/index.html).
Sawyer R, Simpson-Hbert M, Wood S (1998) PHAST step-by-step guide: A participatory approach for the control of diarrhoeal disease. Geneva, World Health Organization (WHO/
EOS/98.3; http://www.who.int/water_sanitation_health/hygiene/envsan/phastep/en/).
Simpson-Hbert M, Sawyer R, Clarke L (1996) The Participatory Hygiene and Sanitation Transformation (PHAST) initiative: a new approach to working with communities. Geneva, World
Health Organization, United Nations Development Programme/World Bank Water and
Sanitation Program (WHO/EOS/96.11; http://www.who.int/water_sanitation_health/
hygiene/envsan/phast/en/).
WHO (1976) Surveillance of drinking-water quality. Geneva, World Health Organization.
WHO (1997) Guidelines for drinking-water quality, 2nd ed. Vol. 3. Surveillance and control of
community supplies. Geneva, World Health Organization (http://www.who.int/water_
sanitation_health/dwq/gdwq2v1/en/index2.html).
Chapter 3
Howard G et al. (2002) Healthy villages: A guide for communities and community health workers. Geneva, World Health Organization (http://www.who.int/water_sanitation_health/
hygiene/settings/hvintro.pdf).
Prss A, Corvalan C (2006) Preventing disease through healthy environments. Towards an estimate of the environmental burden of disease. Geneva, World Health Organization (http://
www.who.int/entity/quantifying_ehimpacts/publications/preventingdisease.pdf).
Prss A et al. (2002) Estimating the burden of disease from water, sanitation, and hygiene at a
global level. Environmental Health Perspectives, 110:537542.
This list includes all references cited in the text, except for the supporting documents to the Guidelines,
which are listed separately in Annex 1, and the selected bibliographic references in chapter 11, which are
cited following each microbial fact sheet in that chapter.
The web links given in this annex were current as of January 2011.
449
Chapter 4
Bartram J, Ballance R, eds (1996) Water quality monitoring: A practical guide to the design
and implementation of freshwater quality studies and monitoring programmes. Published
by E & FN Spon, London, on behalf of the United Nations Educational, Scientific and
Cultural Organization, the World Health Organization and the United Nations Environment Programme (http://www.who.int/entity/water_sanitation_health/resourcesquality/
waterqualmonitor.pdf).
WHO (1997) Guidelines for drinking-water quality, 2nd ed. Vol. 3. Surveillance and control of
community supplies. Geneva, World Health Organization (http://www.who.int/water_
sanitation_health/dwq/gdwq2v1/en/index2.html).
Chapter 5
Lloyd B, Bartram J (1991) Surveillance solutions to microbiological problems in water quality
control in developing countries. Water Science and Technology, 24(2):6175.
WHO (1976) Surveillance of drinking-water quality. Geneva, World Health Organization.
WHO (1997) Guidelines for drinking-water quality, 2nd ed. Vol. 3. Surveillance and control of
community supplies. Geneva, World Health Organization (http://www.who.int/water_
sanitation_health/dwq/gdwq2v1/en/index2.html).
Chapter 6
APHA, AWWA, WEF (2005) Standard methods for the examination of water and wastewater,
21st ed. Washington, DC, American Public Health Association, American Water Works
Association and Water Environment Federation, pp. 715.
Bartram J, Ballance R, eds (1996) Water quality monitoring: A practical guide to the design and
implementation of freshwater quality studies and monitoring programmes. Published by E
& FN Spon, London, on behalf of the United Nations Educational, Scientific and Cultural Organization, the World Health Organization and the United Nations Environment Programme (http://www.who.int/entity/water_sanitation_health/resourcesquality/
waterqualmonitor.pdf).
Cotruvo JA et al. (2010) Desalination technology: Health and environmental impacts. Boca Raton,
FL, CRC Press.
FAO/WHO (2009) Benefits and risks of the use of chlorine-containing disinfectants in food production
and food processing. Report of a Joint FAO/WHO Expert Meeting. Geneva, Food and Agriculture Organization of the United Nations and World Health Organization (http://whqlibdoc.
who.int/publications/2009/9789241598941_eng.pdf).
Hutin Y, Luby S, Paquet C (2003) A large cholera outbreak in Kano City, Nigeria: The importance of hand washing with soap and the danger of street-vended water. Journal of Water
and Health, 1:4552.
WHO (1997) Guidelines for drinking-water quality, 2nd ed. Vol. 3. Surveillance and control of
community supplies. Geneva, World Health Organization (http://www.who.int/water_
sanitation_health/dwq/gdwq2v1/en/index2.html).
WHO (2005a) International Health Regulations (2005), 2nd ed. Geneva, World Health Organization (http://whqlibdoc.who.int/publications/2008/9789241580410_eng.pdf).
WHO (2005b) Nutrients in drinking water. Geneva, World Health Organization (http://www.
bvsde.paho.org/cd-gdwq/Biblioteca/Support%20docs%20GDWQ/nutrientsindw.pdf).
Wisner B, Adams J (2003) Environmental health in emergencies and disasters: a practical guide.
Geneva, World Health Organization (http://www.who.int/water_sanitation_health/
hygiene/emergencies/emergencies2002/en/).
450
Chapter 7
AWWA (1999) Waterborne pathogens: AWWA manual M48. Denver, CO, American Water Works
Association.
Bitton G (2005) Wastewater microbiology, 3rd ed. New York, NY, John Wiley & Sons.
Chevrefils G et al. (2006) UV dose required to achieve incremental log inactivation of bacteria,
protozoa and viruses. IUVA News, 8(1):3845.
Clasen T et al. (2006) Interventions to improve water quality for preventing diarrhoea (Cochrane Review). In: The Cochrane Library, Issue 3. Oxford, Update Software (CD004794).
Cotruvo JA, Sobsey M (2006) Point-of-use water treatment for home and travel. In: Grabow
W, ed. UNESCO encyclopedia of life support systems. Paris, United Nations Educational,
Scientific and Cultural Organization (http://www.eolss.net).
Dullemont YJ et al. (2006) Removal of microorganisms by slow sand filtration. In: Gimbel R,
Graham NJD, Collins MR, eds. Recent progress in slow sand and alternative biofiltration
processes. London, IWA Publishing, pp. 1220.
Feachem RG et al. (1983) Sanitation and disease: Health aspects of excreta and wastewater management. Chichester, John Wiley.
Fewtrell L, Colford J (2004) Water, sanitation and hygiene: Interventions and diarrhoeaA
systematic review and meta-analysis. Health, Nutrition, and Population Family of
the World Bank Human Development Network (http://siteresources.worldbank.
org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/
Fewtrell%26ColfordJuly2004.pdf).
Gerba CP et al. (1996) Waterborne rotavirus: A risk assessment. Water Research, 30(12):2929
2940.
Haas CN, Rose JB, Gerba CP (1999) Quantitative microbial risk assessment. New York, NY,
Wiley.
Hijnen WAM, Beerendonk EF, Medema GJ (2006) Inactivation credit of UV radiation for viruses, bacteria and protozoan (oo)cysts in water: A review. Water Research, 40:322.
Jones K, Betaieb M, Telford DR (1990) Seasonal variation of thermophilic campylobacters in
sewage sludge. Journal of Applied Bacteriology, 69:185189.
Koenraad PMFJ et al. (1994) Survey of Campylobacter in sewage plants in the Netherlands. Food
Microbiology, 11:6573.
Lodder WJ, de Roda Husman AM (2005) Presence of noroviruses and other enteric viruses in
sewage and surface waters in the Netherlands. Applied and Environmental Microbiology,
71(3):14531461.
Lodder WJ et al. (2010) Presence of enteric viruses in source waters for drinking water production in the Netherlands. Applied and Environmental Microbiology, 76(17):59655971.
Maier RM, Pepper IL, Gerba CP (2000) Environmental microbiology. New York, NY, Academic
Press.
Masini L et al. (2007) Research and characterization of pathogenic vibrios from bathing water
along the Conero Riviera (central Italy). Water Research, 41(18):40314040.
Metcalf & Eddy, Inc. (2003) Wastewater engineering: Treatment and reuse. New York, NY,
McGraw Hill.
Nath KJ, Bloomfield S, Jones M (2006) Household water storage, handling and point-of-use treatment. A review commissioned by the International Scientific Forum on Home Hygiene
(http://www.ifh-homehygiene.org/2003/2library/low_res_water_paper.pdf).
Rutjes SA et al. (2009) Detection of infectious rotavirus in naturally contaminated source waters
for drinking water production. Journal of Applied Microbiology, 107(1):97105.
Schijven JF, de Roda Husman AM (2006) A survey of diving behaviour and accidental water
ingestion among Dutch occupational and sport divers to assess the risk of infection with
waterborne pathogenic microorganisms. Environmental Health Perspectives, 114:712717.
451
Stampi S et al. (1992) Occurrence, removal, and seasonal variation of thermophilic campylobacters in a sewage treatment plant in Italy. Zentralblatt fr Hygiene und Umweltmedizin,
193:199210.
Stelzer W (1988) [Detection of Campylobacter jejuni and C. coli in waste water.] Zentralblatt fr
Mikrobiologie, 143(1):4754 (in German).
WHO (2003) Emerging issues in water and infectious disease. Geneva, World Health Organization
(http://www.who.int/water_sanitation_health/emerging/emerging.pdf).
WHO (2005) Preventing travellers diarrhoea: How to make drinking water safe. Geneva, World
Health Organization (http://www.who.int/water_sanitation_health/hygiene/envsan/
sdwtravel.pdf).
World Health Assembly (1991) Elimination of dracunculiasis: Resolution of the 44th World Health
Assembly. Geneva, World Health Organization (Resolution No. WHA 44.5).
Wright J, Gundry S, Conroy R (2003) Household drinking water in developing countries: A
systematic review of microbiological contamination between source and point-of-use.
Tropical Medicine & International Health, 9(1):106117.
Chapter 8
FAO/WHO (2009) Principles and methods for the risk assessment of chemicals in food. Geneva,
Food and Agriculture Organization of the United Nations and the World Health Organization (Environmental Health Criteria 240; http://www.who.int/ipcs/food/principles/en/
index1.html).
IPCS (1994) Assessing human health risks of chemicals: Derivation of guidance values for healthbased exposure limits. Geneva, World Health Organization, International Programme on
Chemical Safety (Environmental Health Criteria 170; http://www.inchem.org/documents/
ehc/ehc/ehc170.htm).
IPCS (2000) Disinfectants and disinfectant by-products. Geneva, World Health Organization,
International Programme on Chemical Safety (Environmental Health Criteria 216; http://
www.inchem.org/documents/ehc/ehc/ehc216.htm).
IPCS (2005) Chemical-specific adjustment factors for interspecies differences and human variability: Guidance document for use of data in dose/concentrationresponse assessment. Geneva,
World Health Organization, International Programme on Chemical Safety (Harmonization Project Document No. 2; http://www.inchem.org/documents/harmproj/harmproj/
harmproj2.pdf).
IPCS (2009) Principles for modelling doseresponse for risk assessment of chemicals. Geneva,
World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 239; http://whqlibdoc.who.int/publications/2009/9789241572392_eng.
pdf).
Solecki R et al. (2005) Guidance on setting of acute reference dose (ARfD) for pesticides. Food
and Chemical Toxicology, 43:15691593 (http://www.who.int/ipcs/food/jmpr/arfd/en/
index.html).
WHO (2006) Guidelines for safe recreational water environments. Vol. 2. Swimming pools and
similar environments. Geneva, World Health Organization (http://whqlibdoc.who.int/
publications/2006/9241546808_eng.pdf).
WHO/TDR (2009) DengueGuidelines for diagnosis, treatment, prevention and control. Geneva,
World Health Organization and the Special Programme for Research and Training in
Tropical Diseases (TDR) (http://whqlibdoc.who.int/publications/2009/9789241547871_
eng.pdf).
452
Chapter 9
APHA, AWWA, WEF (2005) Standard methods for the examination of water and wastewater,
21st ed. Washington, DC, American Public Health Association, American Water Works
Association and Water Environment Federation, pp. 715.
Auvinen A et al. (2005) Radon and other natural radionuclides in drinking water and risks of
stomach cancer: A casecohort study in Finland. International Journal of Cancer, 10:109
113.
Brenner D et al. (2003) Cancer risks attributable to low doses of ionizing radiation: Assessing
what we really know. Proceedings of the National Academy of Sciences of the United States of
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Brown J, Hammond B, Wilkins DT (2008) Handbook for assessing the impact of a radiological
incident on levels of radioactivity in drinking water and risks to operatives at water treatment works: Supporting scientific report. Chilton, Oxfordshire, Health Protection Agency
(HPA-RPD-041; http://www.dwi.gov.uk/research/completed-research/reports/DWI70-2192_supporting.pdf).
European Commission (2001) Commission recommendation of 20 December 2001 on the
protection of the public against exposure to radon in drinking water supplies. Official
Journal of the European Communities, L344:8587 (http://ec.europa.eu/energy/nuclear/
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Health Canada (2009) Guidelines for Canadian drinking water quality: Guideline technical documentRadiological parameters. Ottawa, Ontario, Health Canada, Healthy Environments
and Consumer Safety Branch, Radiation Protection Bureau (Catalogue No. H128-1/10614E-PDF; http://www.hc-sc.gc.ca/ewh-semt/alt_formats/hecs-sesc/pdf/pubs/water-eau/
radiological_para-radiologiques/radiological_para-radiologiques-eng.pdf).
IAEA (2002) Safety requirements on preparedness and response for a nuclear or radiological emergency. Vienna, International Atomic Energy Agency (Safety Standards Series No. GS-R-2).
IAEA, WHO (2005) Development of an extended framework for emergency response criteria.
Vienna, International Atomic Energy Agency (TECDOC-1432).
IAEA, WHO (2010) Criteria for use in planning response to nuclear and radiological emergencies.
Vienna, International Atomic Energy Agency (Safety Guide DS44).
ICRP (1996) Age-dependent doses to the members of the public from intake of radionuclides.
Part 5. Compilation of ingestion and inhalation coefficients. ICRP Publication 72. Annals
of the ICRP, 26(1).
ICRP (2000) Protection of the public in situations of prolonged radiation exposure. Recommendations of the International Commission on Radiological Protection. ICRP Publication 82. Annals of the ICRP, 29(12).
ICRP (2008) The 2007 recommendations of the International Commission on Radiological
Protection. ICRP Publication 103. Annals of the ICRP, 37(24).
ICRP (2009a) Application of the Commissions recommendations for the protection of people
in emergency exposure situations. ICRP Publication 109. Annals of the ICRP, 39(1).
ICRP (2009b) International Commission on Radiological Protection statement on radon (ICRP Ref
00/902/09; http://www.icrp.org/docs/ICRP_Statement_on_Radon%28November_2009%29.
pdf).
ISO (2003) Standard ISO56673: Water qualitySamplingPart3: Guidance on the preservation
and handling of water samples. Geneva, International Organization for Standardization.
ISO (2006a) Standard ISO 56671: Water qualitySamplingPart 1: Guidance on the design
of sampling programmes and sampling techniques. Geneva, International Organization for
Standardization.
453
Chapter 111
WHO (2003) Emerging issues in water and infectious disease. Geneva, World Health Organization
(http://www.who.int/water_sanitation_health/emerging/emerging.pdf).
Selected bibliographical references are included at the end of each microbial fact sheet in chapter 11.
454
Chapter 121
Background documents for preparation of WHO Guidelines for drinking-water
quality2
WHO (2003) 1,1-Dichloroethane in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/19).
WHO (2003) 1,1,1-Trichloroethane in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/65).
WHO (2003) 1,2-Dibromo-3-chloropropane in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization
(WHO/SDE/WSH/03.04/34).
WHO (2003) 1,2-Dibromoethane in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/66).
WHO (2003) 1,2-Dichloroethane in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/67).
WHO (2003) 1,2-Dichloroethene in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/72).
WHO (2003) 1,2-Dichloropropane (1,2-DCP) in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization
(WHO/SDE/WSH/03.04/61).
WHO (2003) 1,3-Dichloropropane in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/35).
WHO (2003) 1,3-Dichloropropene in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/36).
WHO (2003) 2,4-D in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/70).
WHO (2003) 2-Phenylphenol and its sodium salt in drinking-water. Background document for
preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/WSH/03.04/69).
WHO (2003) Alachlor in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/31).
WHO (2003) Aldicarb in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/72).
WHO (2003) Aldrin and dieldrin in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/73).
1
2
References cited using the same author and date in chapter 12 are alphabetized by title here.
ll background documents may be found at http://www.who.int/water_sanitation_health/dwq/
A
chemicals/en/index.html.
455
457
WHO (2003) Endrin in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/93).
WHO (2003) Epichlorohydrin in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/94).
WHO (2003) Ethylbenzene in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/26).
WHO (2003) Fenitrothion in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/95).
WHO (2003) Fluoride in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/96).
WHO (2003) Glyphosate and AMPA in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/97).
WHO (2003) Halogenated acetonitriles in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization
(WHO/SDE/WSH/03.04/98).
WHO (2003) Heptachlor and heptachlor epoxide in drinking-water. Background document for
preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/WSH/03.04/99).
WHO (2003) Hexachlorobenzene in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/100).
WHO (2003) Hexachlorobutadiene in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/101).
WHO (2003) Hydrogen sulfide in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/7).
WHO (2003) Inorganic tin in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/115).
WHO (2003) Iodine in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/46).
WHO (2003) Iron in drinking-water. Background document for preparation of WHO Guidelines for
drinking-water quality. Geneva, World Health Organization (WHO/SDE/WSH/03.04/08).
WHO (2003) Isoproturon in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/37).
WHO (2003) Lindane in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/102).
WHO (2003) Malathion in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/103).
458
WHO (2003) MCPA in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/38).
WHO (2003) Methoxychlor in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/105).
WHO (2003) Methyl parathion in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/106).
WHO (2003) Metolachlor in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/39).
WHO (2003) Molinate in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/40).
WHO (2003) Monochloramine in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/83).
WHO (2003) Monochloroacetic acid in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/85).
WHO (2003) Monochlorobenzene in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/107).
WHO (2003) MX in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/108).
WHO (2003) Nitrilotriacetic acid in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/30).
WHO (2003) Parathion in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/110).
WHO (2003) Pendimethalin in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/41).
WHO (2003) Pentachlorophenol in drinking-water. Background document for preparation of
WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/
SDE/WSH/03.04/62).
WHO (2003) Polynuclear aromatic hydrocarbons in drinking-water. Background document for
preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/WSH/03.04/59).
WHO (2003) Propanil in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/112).
WHO (2003) Silver in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/14).
WHO (2003) Simazine in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/SDE/
WSH/03.04/42).
459
461
WHO (2009) Bacillus thuringiensis israelensis (Bti) in drinking-water: Use for vector control
in drinking-water sources and containers. Background document for development of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/HSE/
WSH/09.01/8).
WHO (2009) Beryllium in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/HSE/
WSH/09.01/5).
WHO (2009) Boron in drinking-water. Background document for preparation of WHO Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/HSE/
WSH/09.01/2).
WHO (2009) Bromide in drinking-water. Background document for preparation of WHO
Guidelines for drinking-water quality. Geneva, World Health Organization (WHO/HSE/
WSH/09.01/6).
WHO (2009) Cyanide in drinking-water. Background document for preparation of WHO
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IPCS (1994) Glyphosate. Geneva, World Health Organization, International Programme on
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IPCS (1994) Hexachlorobutadiene. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 156; http://www.inchem.org/
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IPCS (1997) Aluminium. Geneva, World Health Organization, International Programme on
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IPCS (1997) Hexachlorobenzene. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 195; http://www.inchem.
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IPCS (1998) 1,2-Dichloroethane. Geneva, World Health Organization, International Programme
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IPCS (1999) Bacillus thuringiensis. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 217; http://www.inchem.org/
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IPCS (1999) Carbon tetrachloride. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 208; http://www.who.int/
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467
ANNEX 3
Amitraz
Chlorobenzilate
Chlorothalonil
Cypermethrin
Deltamethrin
Diazinon
Dinoseb
Ethylene thiourea
Fenamiphos
Formothion
Hexachlorocyclohexanes
(mixed isomers)
MCPBa
Methamidophos
Methomyl
Mirex
Monocrotophos
Oxamyl
Phorate
Propoxur
Pyridate
Quintozene
Toxaphene
Triazophos
Tributyltin oxide
Trichlorfon
a
4-(4-chloro-o-tolyloxy)butyric acid.
468
Table A3.2 Chemicals for which guideline values have not been established
Chemical
Aluminium
Ammonia
Asbestos
Bentazone
Beryllium
Bromide
Bromochloroacetate
Bromochloroacetonitrile
Carbaryl
Chloral hydrate
Chloride
Chlorine dioxide
Chloroacetones
2-Chlorophenol
Chloropicrin
Cyanide
Cyanogen chloride
Dialkyltins
Dibromoacetate
469
Dichloramine
1,3-Dichlorobenzene
1,1-Dichloroethane
1,1-Dichloroethene
2,4-Dichlorophenol
1,3-Dichloropropane
Di(2-ethylhexyl)adipate
Diflubenzuron
Diquat
May be used as an aquatic herbicide for the control of freefloating and submerged aquatic weeds in ponds, lakes and
irrigation ditches, but rarely found in drinking-water
Endosulfan
Fenitrothion
Fluoranthene
Formaldehyde
Hardness
Hexachlorobenzene
Hydrogen sulfide
Inorganic tin
Iodine
Iron
Malathion
470
Manganese
Methoprene
Methyl parathion
Molybdenum
Monobromoacetate
Monochlorobenzene
MX
Nitrobenzene
Novaluron
Parathion
Permethrin
Petroleum products
pH
Pirimiphos-methyl
Potassium
Propanil
Pyriproxyfen
Silver
Sodium
471
Spinosad
Sulfate
Temephos
Trichloramine
Trichloroacetonitrile
Trichlorobenzenes (total)
1,1,1-Trichloroethane
Zinc
Table A3.3Guideline values for chemicals that are of health significance in drinking-water
Guideline value
Chemical
mg/l
g/l
Acrylamide
0.000 5
0.5
Alachlor
0.02a
20a
Aldicarb
0.01
10
0.000 03
Antimony
0.02
0.03
Arsenic
0.01 (A, T)
0.1
100
Barium
0.7
700
Benzene
0.01a
Benzo[a]pyrene
0.000 7
Boron
2.4
Bromate
0.01 (A, T)
10a (A, T)
Bromodichloromethane
0.06
60a
20
10 (A, T)
10a
a
0.7a
2 400
Remarks
Bromoform
0.1
Cadmium
0.003
100
3
Carbofuran
0.007
Carbon tetrachloride
0.004
4
472
mg/l
Chlorate
0.7 (D)
Chlordane
0.000 2
Chlorine
5 (C)
g/l
700 (D)
0.2
5 000 (C)
Chlorite
0.7 (D)
700 (D)
Chloroform
0.3
300
Chlorotoluron
0.03
30
Chlorpyrifos
0.03
30
Chromium
0.05 (P)
50 (P)
Copper
2 000
Cyanazine
0.000 6
2,4-Db
0.03
30
0.09
90
2,4-DB
0.6
0.001
Dibromoacetonitrile
0.07
70
100
Dibromochloromethane
0.1
1,2-Dibromo-3chloropropane
0.001a
1a
1,2-Dibromoethane
0.000 4a (P)
0.4a (P)
Dichloroacetate
0.05 (D)
50a (D)
Dichloroacetonitrile
0.02 (P)
20 (P)
1,2-Dichlorobenzene
1 (C)
1,4-Dichlorobenzene
0.3 (C)
300 (C)
1,2-Dichloroethane
0.03a
30a
1,2-Dichloroethene
0.05
50
Dichloromethane
0.02
20
Remarks
1 000 (C)
1,2-Dichloropropane
0.04 (P)
40 (P)
1,3-Dichloropropene
0.02a
20a
Dichlorprop
0.1
Di(2-ethylhexyl)phthalate
0.008
100
8
Dimethoate
0.006
1,4-Dioxane
0.05a
50a
473
mg/l
Edetic acid
0.6
Endrin
0.000 6
Epichlorohydrin
0.000 4 (P)
Ethylbenzene
0.3 (C)
Fenoprop
0.009
Fluoride
1.5
g/l
Remarks
600
0.6
0.4 (P)
300 (C)
9
1 500
Hexachlorobutadiene
0.000 6
Hydroxyatrazine
0.2
0.6
200
Isoproturon
0.009
Lead
0.01 (A, T)
0.002
MCPAe
0.002
2
10
Mecoprop
0.01
Mercury
0.006
Methoxychlor
0.02
20
Metolachlor
0.01
10
Microcystin-LR
0.001 (P)
1 (P)
Molinate
0.006
Monochloramine
3
0.02
Nickel
0.07
3 000
20
70
50
50 000
Nitrilotriacetic acid
0.2
N-Nitrosodimethylamine
0.000 1
Pendimethalin
0.02
Pentachlorophenol
0.009 (P)
Short-term exposure
200
3 000
Short-term exposure
0.1
20
Selenium
0.04 (P)
Simazine
0.002
Sodium
dichloroisocyanurate
Atrazine metabolite
10 (A, T)
Lindane
Monochloroacetate
9a (P)
40 (P)
2
50
50 000
As sodium dichloroisocyanurate
40
40 000
As cyanuric acid
Styrene
0.02 (C)
20 (C)
2,4,5-Tf
0.009
Terbuthylazine
0.007
Tetrachloroethene
0.04
40
474
Guideline value
Remarks
Chemical
mg/l
Simazine
0.002
50
50 000
As sodium dichloroisocyanurate
As cyanuric acid
Sodium
dichloroisocyanurate
g/l
40
40 000
Styrene
0.02 (C)
20 (C)
2,4,5-Tf
0.009
Terbuthylazine
0.007
Tetrachloroethene
0.04
40
0.7 (C)
700 (C)
Toluene
Trichloroacetate
0.2
200
Trichloroethene
0.02 (P)
20 (P)
2,4,6-Trichlorophenol
0.2 (C)
200 (C)
0.02
20
Trifluralin
Trihalomethanes
Uranium
0.03 (P)
30 (P)
Vinyl chloride
0.0003a
0.3a
Xylenes
0.5 (C)
500 (C)
A, provisional guideline value because calculated guideline value is below the achievable quantification level; C,
concentrations of the substance at or below the health-based guideline value may affect the appearance, taste or
odour of the water, leading to consumer complaints; D, provisional guideline value because disinfection is likely
to result in the guideline value being exceeded; P, provisional guideline value because of uncertainties in the
health database; T, provisional guideline value because calculated guideline value is below the level that can be
achieved through practical treatment methods, source protection, etc.
a
For substances that are considered to be carcinogenic, the guideline value is the concentration in drinkingwater associated with an upper-bound excess lifetime cancer risk of 105 (one additional case of cancer per
100 000 of the population ingesting drinking-water containing the substance at the guideline value for 70
4
6
years). Concentrations associated with upper-bound estimated excess lifetime cancer risks of 10 and 10
can be calculated by multiplying and dividing, respectively, the guideline value by 10.
b
2,4-Dichlorophenoxyacetic acid.
c
2,4-Dichlorophenoxybutyric acid.
d
Dichlorodiphenyltrichlorethane.
e
4-(2-Methyl-4-chlorophenoxy)acetic acid.
24
ANNEX 4
476
Electrothermal atomic absorption spectrometry (EAAS) is based on the same principle as FAAS, but an electrically heated atomizer or graphite furnace replaces the
standard burner head for determination of metals. In comparison with FAAS, EAAS
gives higher sensitivities and lower detection limits, and a smaller sample volume is
required. EAAS suffers from more interference through light scattering by co-existing
elements and requires a longer analysis time than FAAS.
The principle of inductively coupled plasma atomic emission spectrometry (ICPAES) for determination of metals is as follows. An ICP source consists of a flowing stream of argon gas ionized by an applied radio frequency. A sample aerosol
is generated in a nebulizer and spray chamber and then carried into the plasma
through an injector tube. A sample is heated and excited in the high-temperature
plasma. The high temperature of the plasma causes the atoms to become excited. On
returning to the ground state, the excited atoms produce ionic emission spectra. A
monochromator is used to separate specific wavelengths corresponding to different
elements, and a detector measures the intensity of radiation of each wavelength. A
significant reduction in chemical interference is achieved. In the case of water with
low pollution, simultaneous or sequential analysis is possible without special pretreatment to achieve low detection limits for many elements. This, coupled with the
extended dynamic range from three digits to five digits, means that multielement
determination of metals can be achieved. ICP-AES has similar sensitivity to FAAS
or EAAS.
In inductively coupled plasma mass spectrometry (ICP-MS), elements are atomized
and excited as in ICP-AES, then passed to a mass spectrometer. Once inside the mass
spectrometer, the ions are accelerated by high voltage and passed through a series of
ion optics, an electrostatic analyser and, finally, a magnet. By varying the strength of
the magnet, ions are separated according to mass/charge ratio and passed through a
slit into the detector, which records only a very small atomic mass range at a given
time. By varying the magnet and electrostatic analyser settings, the entire mass range
can be scanned within a relatively short period of time. In the case of water with low
pollution, simultaneous or sequential analysis is possible without special pretreatment
to achieve low detection limits for many elements. This, coupled with the extended
dynamic range from three digits to five digits, means that multielement determination
of metals can be achieved.
Chromatography is a separation method based on the affinity difference between
two phases, the stationary and mobile phases. A sample is injected into a column,
either packed or coated with the stationary phase, and separated by the mobile phase
based on the difference in interaction (distribution or adsorption) between compounds and the stationary phase. Compounds with a low affinity for the stationary
phase move more quickly through the column and elute earlier. The compounds that
elute from the end of the column are determined by a suitable detector.
In ion chromatography, an ion exchanger is used as the stationary phase, and the
eluant for determination of anions is typically a dilute solution of sodium hydrogen
carbonate and sodium carbonate. Colorimetric, electrometric or titrimetric detectors
can be used for determining individual anions. In suppressed ion chromatography, anions are converted to their highly conductive acid forms; in the carbonatebicarbonate
477
eluant, anions are converted to weakly conductive carbonic acid. The separated acid
forms are measured by conductivity and identified on the basis of retention time as
compared with their standards.
High-performance liquid chromatography (HPLC) is an analytical technique using
a liquid mobile phase and a column containing a liquid stationary phase. Detection
of the separated compounds is achieved through the use of absorbance detectors for
organic compounds and through conductivity or electrochemical detectors for metallic and inorganic compounds.
Gas chromatography (GC) permits the identification and quantification of trace
organic compounds. In GC, gas is used as the mobile phase, and the stationary phase
is a liquid that is coated either on an inert granular solid or on the walls of a capillary column. When the sample is injected into the column, the organic compounds
are vaporized and moved through the column by the carrier gas at different rates
depending on differences in partition coefficients between the mobile and stationary phases. The gas exiting the column is passed to a suitable detector. A variety of
detectors can be used, including flame ionization (FID), electron capture (ECD) and
nitrogenphosphorus. As separation ability is good in this method, mixtures of substances with similar structure are systematically separated, identified and determined
quantitatively in a single operation.
The gas chromatography/mass spectrometry (GC-MS) method is based on the
same principle as the GC method, using a mass spectrometer as the detector. As
the gas emerges from the end of the GC column opening, it flows through a capillary column interface into the MS. The sample then enters the ionization chamber,
where a collimated beam of electrons impacts the sample molecules, causing ionization and fragmentation. The next component is a mass analyser, which uses a
magnetic field to separate the positively charged particles according to their mass.
Several types of separating techniques exist; the most common are quadrupoles
and ion traps. After the ions are separated according to their masses, they enter a
detector.
The purge-and-trap packed column GC-MS method or purge-and-trap packed
column GC method is applicable to the determination of various purgeable organic
compounds that are transferred from the aqueous to the vapour phase by bubbling
purge gas through a water sample at ambient temperature. The vapour is trapped with
a cooled trap. The trap is heated and backflushed with the same purge gas to desorb
the compounds onto a GC column. The principles of GC or GC-MS are as referred
to above.
The principle of enzyme-linked immunosorbent assay (ELISA) is as follows. The
protein (antibody) against the chemical of interest (antigen) is coated onto the solid
material. The target chemical in the water sample binds to the antibody, and a second
antibody with an enzyme attached is also added that will attach to the chemical of
interest. After washing to remove any of the free reagents, a chromogen is added that
will give a colour reaction due to cleavage by the enzyme that is proportional to the
quantity of the chemical of interest. The ELISA method can be used to determine
microcystin and synthetic surfactants.
478
Absor
Laboratory methods
IC
FAAS
EAAS
ICP
For definitions and notes to Table A4.1, see below Table A4.6.
479
ICP-MS
+++
+++
+++
+++
+++
+++
+++
+++
+++
+++
+++
480
+++
+++
+++
+++
Tetrachloroethene
Toluene
Trichloroethene
Xylenes
+++
+++
+++
++
For definitions and notes to Table A4.2, see below Table A4.6.
+++
Styrene
Pentachlorophenol
Nitrilotriacetic acid
++
Hexachlorobutadiene
+++
+++
+++
+++
Edetic acid
+++
+++
1,4-Dioxane
Ethylbenzene
++
+++
+++
+++
+++
+++
+++
+++
++
+++
+++
+++
+++
+++
+++
+++
+++
Di(2-ethylhexyl)phthalate
+++
+++
1,2-Dichloroethene
Dichloromethane
+++
1,2-Dichloroethane
+++
+++
1,4-Dichlorobenzene
+++
+++
+++
1,2-Dichlorobenzene
+++
(PT-)
(PT-)
GC-PD GC-ECD GC-FID
+++
+++
GC
Carbon tetrachloride
Benzene
Col
Table A4.2 Analytical achievability for organic chemicals from industrial sources and human dwellings for which guideline values have been establisheda
Aldicarb
Aldrin and dieldrin
Atrazine and its chloros-triazine metabolites
Carbofuran
Chlordane
Chlorotoluron
Cyanazine
2,4-D
2,4-DB
1,2-Dibromo-3-chloro
propane
1,2-Dibromoethane
1,2-Dichloropropane
1,3-Dichloropropene
Dichlorprop
Dimethoate
Endrin
Fenoprop
Hydroxyatrazine
Isoproturon
Lindane
MCPA
Alachlor
Col
++
GC
++
+++
+++
GC-MS
481
+++
+++
+++
+++
+++
+++
+++
+++
+++
+++
+++
+++
+++
+++
++
+++
GC-TID
++
+++
+++
+++
GC-FPD
+++
+++
+++
+++
++
+++
GC-FID
+++
++
+++
+++
+++
+++
+++
+++
PT-GC-MS
HPLC
+++
HPLC-FD
+
+++
+++
+++
+
++
++
+++
HPLCUVPAD
Table A4.3 Analytical achievability for organic chemicals from agricultural activities for which guideline values have been establisheda,b
EAAS
IC-FD
Col
+++
+++
GC
+++
+++
+++
+++
+++
482
GC-FID
GC-FPD
GC-TID
+++
+++
+++
+++
+++
+++
+++
+++
GC-MS
PT-GC-MS
HPLC
HPLC-FD
+
++
HPLCUVPAD
EAAS
IC-FD
+++
Chlorine
+++
Bromoform
Chlorate
+++
+++
+++
+++
+++
+++
+++
(PT-)
GC-ECD GC-FID GC-FPD GC-TID GC-MS PT-GC-MS HPLC HPLC-FD HPLC-UVPAD EAAS
+++
(PT-)
GC GC-PD
Bromodichloromethane
Bromate
Disinfection by-products
Sodium
dichloroisocyanurate
+++
Monochloramine
Disinfectants
Col
+++
++
IC
Table A4.4 Analytical achievability for chemicals used in water treatment or from materials in contact with water for which guideline values have been
establisheda
For definitions and notes to Table A4.3, see below Table A4.6.
b
LC-MS is also applicable for many of these agricultural chemicals.
Mecoprop
Methoxychlor
Metolachlor
Molinate
Pendimethalin
Simazine
2,4,5-T
Terbuthylazine
Trifluralin
483
For definitions and notes to Table A4.4, see below Table A4.6.
See also individual trihalomethanes.
++
++
+++
+++
++
+++
+++
+++
+++
++
++
For definitions and notes to Table A4.5, see below Table A4.6.
GC
Chlorpyrifos
Col
GC-TID
++
GC-FPD
++
++
+++
HPLC-FD
HPLC-UVPAD
EAAS
Table A4.5 Analytical achievability for pesticides used in water for public health purposes for which guideline values have been establisheda
Vinyl chloride
Benzo[a]pyrene
Epichlorohydrin
Acrylamide
Trihalomethanesb
+++
+++
+++
2,4,6-Trichlorophenol
++
+++
+++
+++
Monochloroacetic acid
+++
+++
Dichloroacetonitrile
+++
+++
Trichloroacetic acid
+++
Dichloroacetic acid
+++
+++
+++
N-Nitrosodimethylamine
+++
Dibromochloromethane
+++
+++
IC
IC/FD
(PT-)
GC-ECD GC-FID GC-FPD GC-TID GC-MS PT-GC-MS HPLC HPLC-FD HPLC-UVPAD EAAS
Dibromoacetonitrile
(PT-)
GC GC-PD
+++
Col
Chloroform
Chlorite
484
(H)
+
++
+++
#
Absorptiometry
Colorimetry
Electrothermal atomic absorption spectrometry
Enzyme-linked immunosorbent assay
Flame atomic absorption spectrometry
Gas chromatography
Gas chromatographyelectron capture detector
Gas chromatographyflame ionization detector
Gas chromatographyflame photodiode detector
Gas chromatographymass spectrometry
Gas chromatographyphotoionization detector
Gas chromatographythermal ionization detector
HPLC
HPLC-FD
HPLC-UVPAD
IC
IC-FAAS
IC-FD
ICP
ICP-MS
LC-MS
PPA
PT-GC-MS
++
ELISA
++
HPLC-UVPAD
++
LC-MS
GC-MS
The detection limit is between the guideline value and 1/10th of its value.
The detection limit is between 1/10th and 1/50th of the guideline value.
The detection limit is less than 1/100th of the guideline value.
The analytical method is available for detection of the guideline value concentration, but it is difficult to detect the concentration of 1/10 of the
guideline value.
This method is applicable to the determination by conversion to their hydrides by hydride generator.
Absor
Col
EAAS
ELISA
FAAS
GC
GC-ECD
GC-FID
GC-FPD
GC-MS
GC-PD
GC-TID
Microcystin-LR
PPA
Table A4.6 Analytical achievability for cyanobacterial toxins for which guideline values have been established
ANNEX 5
485
487
single-medium filters, which can allow higher flow rates without increasing headloss
development.
Rapid gravity filters are most commonly used to remove floc from coagulated
waters (see section A5.1.6). They may also be used to reduce turbidity (including
adsorbed chemicals) and oxidized iron and manganese from raw waters.
Roughing filters
Roughing filters can be applied as pre-filters prior to other processes such as slow sand
filters. Roughing filters with coarse gravel or crushed stones as the filter medium can
successfully treat water of high turbidity (>50 nephelometric turbidity units). The
main advantage of roughing filtration is that as the water passes through the filter,
particles are removed by both filtration and gravity settling. Horizontal filters can be
up to 10 m long and are operated at filtration rates of 0.31.0 m3/m2h.
Pressure filters
Pressure filters are sometimes used where it is necessary to maintain head in order to
eliminate the need for pumping into supply. The filter bed is enclosed in a cylindrical
shell. Small pressure filters, capable of treating up to about 15 m3/h, can be manufactured in glass-reinforced plastics. Larger pressure filters, up to 4 m in diameter, are
manufactured in specially coated steel. Operation and performance are generally as
described for the rapid gravity filter, and similar facilities are required for backwashing
and disposal of the dilute sludge.
Slow sand filters
Slow sand filters usually consist of tanks containing sand (effective size range 0.150.3
mm) to a depth of between 0.5 and 1.5 m. The raw water flows downwards, and turbidity and microorganisms are removed primarily in the top few centimetres of the
sand. A biological layer, known as the schmutzdecke, develops on the surface of the
filter and can be effective in removing microorganisms. Treated water is collected in
underdrains or pipework at the bottom of the filter. The top few centimetres of sand
containing the accumulated solids are removed and replaced periodically. Slow sand
filters are operated at a water flow rate of between 0.1 and 0.3 m3/m2h.
Slow sand filters are more suitable for low-turbidity water or water that has been
pre-filtered. They are used to remove algae and microorganisms, including protozoa,
and, if preceded by microstraining or coarse filtration, to reduce turbidity (including
adsorbed chemicals). Slow sand filtration is effective for the removal of some organics,
including certain pesticides and also ammonia.
Bank filtration
Bank filtration is a process that produces an influx of surface water through the groundwater, via the bed and banks of the surface water body. This is commonly achieved
through abstraction from boreholes adjacent to the surface water source. It is a relatively simple and low-cost means for removing particulates and microorganisms from
surface water by placing pumping wells in alluvial sediments of the river or stream
banks. The sediments act as both a filter and biofilter, trapping and reducing the concentrations of microorganisms and many organic pollutants. Bank filtration wells can
488
volume treated would be much lower than the dose of PAC required to achieve the
same removal.
GAC is used for taste and odour control. It is normally used in fixed beds, either
in purpose-built adsorbers for chemicals or in existing filter shells by replacement of
sand with GAC of a similar particle size. Although at most treatment works it would be
cheaper to convert existing filters rather than build separate adsorbers, use of existing
filters usually allows only short contact times, and they are not capable of facile reactivation. It is therefore common practice to install additional GAC adsorbers (in some
cases preceded by ozonation) between the rapid gravity filters and final disinfection.
Most groundwater sources do not have existing filters, and separate adsorbers would
need to be installed.
The service life of a GAC bed is dependent on the capacity of the carbon used
and the contact time between the water and the carbon, the empty bed contact time,
controlled by the flow rate of the water. Empty bed contact times are usually in the
range 530 minutes. GACs vary considerably in their capacity for specific organic
compounds, which can have a significant effect upon their service life. A guide to
capacity can be obtained from published isotherm data. Carbon capacity is strongly
dependent on the water source and is greatly reduced by the presence of background
organic compounds. The properties of a chemical that influence its adsorption onto
activated carbon include the water solubility and octanolwater partition coefficient.
As a general rule, chemicals with low solubilities and high log octanolwater partition
coefficients are well adsorbed.
Activated carbon is used for the removal of pesticides and other organic chemicals, taste and odour compounds, cyanobacterial toxins and total organic carbon.
A5.1.8 Ion exchange
Ion exchange is a process in which ions of like charge are exchanged between the water
phase and the solid resin phase. Water softening is achieved by cation exchange. Water
is passed through a bed of cationic resin, and the calcium ions and magnesium ions in
the water are replaced by sodium ions. When the ion exchange resin is exhausted (i.e.
the sodium ions are depleted), it is regenerated using a solution of sodium chloride.
The process of dealkalization can also soften water. Water is passed through a bed
of weakly acidic resin, and the calcium and magnesium ions are replaced by hydrogen
ions. The hydrogen ions react with the carbonate and bicarbonate ions to produce carbon dioxide. The hardness of the water is thus reduced without any increase in sodium
levels. Anion exchange can be used to remove contaminants such as nitrate, fluoride,
arsenate and uranium (as the uranyl anion), which are exchanged for chloride. Several
appropriate resins are available for this purpose.
An ion exchange plant normally consists of two or more resin beds contained in
pressure shells with appropriate pumps, pipework and ancillary equipment for regeneration. The pressure shells are typically up to 4 m in diameter, containing 0.61.5
m depth of resin.
Cation exchange can be used for removal of certain heavy metals. Potential applications of anionic resins, in addition to nitrate removal, are for removal of arsenic
and selenium species.
491
ozone or with the hydroxyl radical (HO), which is a product of the decomposition
of ozone in water and is an exceedingly powerful indiscriminate oxidant that reacts
readily with a wide range of organic chemicals. The formation of hydroxyl radicals
can be encouraged by using ozone at high pH. One advanced oxidation process using
ozone or UV plus hydrogen peroxide involves dosing hydrogen peroxide simultaneously with ozone at a rate of approximately 0.4 mg of hydrogen peroxide per litre per
milligram of ozone dosed per litre (the theoretical optimum ratio for hydroxyl radical
production) and bicarbonate.
Other treatment processes that can be used in certain applications include:
++
Uranium
+++
<0.01
+++
<0.001
+++
<0.005
++
++
<0.005
+++
<0.005
+++
<1
+++
<0.01
+++
<0.001
+++d
<0.005
+++
<1
+++
<0.01
Ion exchange Precipitation softening Activated alumina Activated carbon Ozonation Membranes
++
Selenium
Coagulation
Fluoride
Chlorination
++
<0.005
++
Arsenicc
Table A5.1 Treatment performance for naturally occurring chemicals for which guideline values have been establisheda,b
494
495
Hexachlorobutadiene
Ethylbenzene
Edetic acid
1,4-Dioxane
++
<0.001
+++
<0.01
1,2-Dichloroethene
1,2-Dichloroethane
+++
<0.01
+++
+++
<0.01
+++
<0.001
+++
<0.01
1,4-Dichlorobenzene
1,2-Dichlorobenzene
Carbon tetrachloride
Benzene
Mercury
Cadmium
+++
<0.002
+++
<0.0001
+++
<0.002
+++
<0.002
+++
<0.0001
+++
<0.01
+++
<0.001
+++
<0.001
+++
<0.01
+++
<0.01
+++
<0.01
+
+++
<0.0001
+++
<0.01
+++
<0.001
+++
<0.01
+++
<0.001
+++
<0.01
+++
<0.01
+++
<0.01
+++
<0.01
++
+++
0.05
Yesd
Yesd
Yesd
+++
<0.002
+++
<0.0001
++
Air
Ion
Precipitation Activated
Advanced
Biological
stripping Coagulation exchange
softening
carbon
Ozonation oxidation Membranes treatmentc
UV
irradiation
Table A5.2 Treatment performance for chemicals from industrial sources and human dwellings for which guideline values have been establisheda,b
496
+++
<0.02
+++
<0.005
+++
<0.02
+++
<0.001
+++
<0.001
+++
<0.02
+++
<0.005
++
+
+++
<0.0004
+++
<0.002
+++
<0.001
+++
<0.001
+++
<0.02
+++
<0.001
++
+++e
<0.001
+++e
<0.02
+++e
<0.005
++
++
++
++
<0.001
++
Air
Ion
Precipitation Activated
Advanced
Biological
stripping Coagulation exchange
softening
carbon
Ozonation oxidation Membranes treatmentc
+
UV
irradiation
Xylenes
Trichloroethene
Toluene
Tetrachloroethene
Styrene
Nitrilotriacetic acid
N-Nitrosodimethylamine
Pentachlorophenol
497
++
<0.001
1,2-Dibromo-3-chloropropane
2,4-D
Cyanazine
Chlorotoluron
Chlordane
Carbofuran
+++
<0.001
+++
<0.0001
+++
<0.0001
+++
<0.0001
+++
<0.001
+++
<0.0001
+++
<0.001
+++
<0.000 02
+++
<0.0001
Aldicarb
Aldrin/dieldrin
+++
<0.001
+++
<0.1
+++
<5
Activated
carbon
Alachlor
Nitrite
Nitrate
Ion
Chlorination Air stripping Coagulation exchange
+++
<0.001
++
<0.0001
+++
<0.0001
+
Yesd
+++
<0.001
++
<0.000 02
Yesd
++
Ozonation
+++
<0.0001
+++
<0.001
Advanced
oxidation
+++
<0.0001
Yesd
+++
<0.001
Yesd
+++
<0.001
+++
<0.000 02
+++
<0.0001
+++
<0.001
+++
<5
Membranes
Table A5.3 Treatment performance for chemicals from agricultural activities for which guideline values have been establisheda,b
+++e
<0.0001
+++
+++
<5
Biological
treatmentc
498
Simazine
Metalochlor
Methoxychlor
Mecoprop
MCPA
Lindane
Isoproturon
Hydroxyatrazine
Endrin
Dimethoate
1,2-Dichloropropane
1,2-Dibromoethane
++
+++
<0.001
+++
<0.0001
Yes
++
Ion
Chlorination Air stripping Coagulation exchange
+++
<0.0001
+++
<0.0001
+++
<0.0001
+++
<0.0001
+++
<0.0001
+++
<0.0001
+++
<0.0001
+++
<0.0002
+++
<0.0001
+++
<0.001
++
Activated
carbon
+++
<0.0001
++
Yesd
Yesd
+++
<0.0001
Yesd
Yesd
Yesd
Membranes
Yesd
+++
<0.0001
+++
<0.001
+++
<0.0001
Advanced
oxidation
++
+++
<0.0001
+++
<0.0001
+++
<0.0001
+++
<0.0001
++
++
Ozonation
++
+++
<0.0001
++
Biological
treatmentc
++
Ozonation
Advanced
oxidation
+++f
<0.0001
Yesd
Membranes
Biological
treatmentc
Trifluralin
+++
<0.0001
+++
<0.0001
Terbuthylazine
Activated
carbon
+++
<0.001
Ion
Chlorination Air stripping Coagulation exchange
2,4,5-T
499
Coagulation
+++
<0.0001
Activated carbon
+
Ozonation
Membranes
+++c
<0.0001
+++
<0.0001
500
+++
+++
+++
+++
+++
+++
+++
Biological treatmentd
Cyanotoxins
Cyanobacterial cells
Table A5.5 Treatment performance for cyanobacterial cells and cyanotoxins for which guideline values have been establisheda,b,c
Advanced oxidation
Chlorination
Table A5.4 Treatment performance for pesticides used in water for public health for which guideline values have been establisheda,b
or to chemical attack by aggressive ions such as chloride or sulfate, and this may result
in structural failure. Newly installed cement materials will leach lime, with consequent
increases in pH, alkalinity and hardness. Cement contains a variety of metals that
can be leached into the water. Aggressiveness to cement is related to the aggressivity
index, which has been used specifically to assess the potential for the dissolution of
concrete. A pH of 8.5 or higher may be necessary to control cement corrosion.
A5.3.3 Copper
The corrosion of copper pipework and hot water cylinders can cause blue water, blue
or green staining of bathroom fittings and, occasionally, taste problems. Copper tubing may be subject to general corrosion, impingement attack and pitting corrosion.
General corrosion is most often associated with soft, acidic waters; waters with
pH below 6.5 and hardness of less than 60 mg of calcium carbonate per litre are very
aggressive to copper. Copper, like lead, can enter water by dissolution of the corrosion
product, basic copper carbonate. The solubility is mainly a function of pH and total
inorganic carbon. Solubility decreases with increase in pH, but increases with increase
in concentrations of carbonate species. Raising the pH to between 8 and 8.5 is the
usual procedure to overcome these difficulties.
Impingement attack is the result of excessive flow velocities and is aggravated in
soft water at high temperature and low pH.
The pitting of copper is commonly associated with hard groundwaters having a
carbon dioxide concentration above 5 mg/l and high dissolved oxygen. Phosphates
have been used to suppress copper corrosion in those cases. Surface waters with
organic colour may also be associated with pitting corrosion. Copper pipes can fail by
pitting corrosion, which involves highly localized attacks leading to perforations with
negligible loss of metal. Two main types of attack are recognized. Type I pitting affects
cold water systems (below 40C) and is associated, particularly, with hard borehole
waters and the presence of a carbon film in the bore of the pipe, derived from the
manufacturing process. Tubes that have had the carbon removed by cleaning are immune from Type I pitting. Type II pitting occurs in hot water systems (above 60 C)
and is associated with soft waters. A high proportion of general and pitting corrosion
problems are associated with new pipe in which a protective oxide layer has not yet
formed. Calcium carbonate precipitation indices such as Langelier and Ryznar are not
good predictors of corrosion for copper systems.
A5.3.4 Iron
Iron (either cast or ductile) is frequently used in water distribution systems, and its
corrosion is of concern. While structural failure as a result of iron corrosion is rare,
water quality problems (e.g. red water) can arise as a result of excessive corrosion of
iron pipes. The corrosion of iron is a complex process that involves the oxidation of
the metal, normally by dissolved oxygen, ultimately to form a precipitate of iron(III).
This leads to the formation of tubercules on the pipe surface. The major water quality factors that determine whether the precipitate forms a protective scale are pH and
alkalinity. The concentrations of calcium, chloride and sulfate also influence iron corrosion. Successful control of iron corrosion has been achieved by adjusting the pH to
501
the range 6.87.3, hardness and alkalinity to at least 40mg/l (as calcium carbonate),
oversaturation with calcium carbonate of 410mg/l and a ratio of alkalinity to chloride plus sulfate of at least 5 (when both are expressed as calcium carbonate).
Silicates and polyphosphates are often described as corrosion inhibitors, but
there is no guarantee that they will inhibit corrosion in water distribution systems.
However, they can complex dissolved iron (in the iron(II) state) and prevent its precipitation as visibly obvious red rust. These compounds may act by masking the effects of corrosion rather than by preventing it. Orthophosphate is a possible corrosion
inhibitor and, like polyphosphates, is used to prevent red water.
A5.3.5 Lead
Lead corrosion (plumbosolvency) is of particular concern. Lead piping is still common in old houses in some countries, lead solders have been used widely for jointing
copper tubing and brass fittings can contain substantial amounts of lead. Galvanized
iron pipe plumbing can accumulate incoming lead and release it at a later time as
particulates. The solubility of lead is governed by the formation of lead carbonates as
pipe deposits. Wherever practicable, lead pipework should be replaced. Lead can also
leach from lead-based solders and brass and bronze fittings.
The solubility of corrosion-related lead salts increases markedly as the pH increases above or decreases below 8.3 because of the substantial decrease in the equilibrium carbonate concentration. Thus, plumbosolvency tends to be at a maximum
in waters with a low pH and low alkalinity, and a useful interim control procedure,
pending pipe replacement, is to increase the pH to 8.08.5 after chlorination prior to
distribution. Orthophosphate and other phosphates are effective in suppressing dissolution of lead.
Lead concentrations increase with increasing standing time of water in lead pipe.
Flushing the pipework before drawing water for consumption can be used as an interim measure to reduce exposure to lead. Showering, bathing and flushing the toilet
can be used to flush out the system.
Lead can corrode more rapidly when it is coupled to copper. The rate of such galvanic corrosion is faster than that of simple oxidative corrosion, and lead concentrations are not limited by the solubility of the corrosion products. The rate of galvanic
corrosion is affected principally by chloride concentration. Galvanic corrosion is less
easily controlled but can be reduced by dosing zinc in conjunction with orthophosphate and by adjustment of pH.
Treatment to reduce plumbosolvency usually involves pH adjustment. When
the water is very soft (calcium carbonate concentration less than 50 mg/l), the optimum pH is about 8.08.5. Alternatively, dosing with orthophosphoric acid or sodium
orthophosphate might be more effective, particularly when plumbosolvency occurs
in non-acidic waters. Calcium carbonate precipitation indices such as Langelier and
Ryznar are not considered to be necessarily good predictors of corrosion for lead.
A5.3.6 Nickel
Nickel in water may arise due to the leaching of nickel from new nickel/chromiumplated taps. Low concentrations may also arise from stainless steel pipes and fittings.
502
Nickel leaching falls off over time. An increase of pH to control corrosion of other
materials should also reduce leaching of nickel.
A5.3.7 Zinc
Galvanized pipes will release zinc (from the galvanizing layer) and can also leach cadmium and lead. Corrosion can be a particular problem where galvanized steel or iron
piping is connected to dissimilar materials, such as brass, in taps and fittings.
The solubility of zinc in water is a function of pH and total inorganic carbon
concentrations; the solubility of basic zinc carbonate decreases with increase in pH
and concentrations of carbonate species. For low-alkalinity waters, an increase of pH
to 8.5 should be sufficient to control the dissolution of zinc.
With galvanized iron, the zinc layer initially protects the steel by corroding preferentially. In the long term, a protective deposit of basic zinc carbonate forms; however,
galvanized pipe is also prone to uncontrolled deposition and clogging. Recent findings
have shown that lead can accumulate on galvanized pipe particulates and become
resuspended by physical disruption, such as water hammer. Protective deposits do
not form in soft waters where the alkalinity is less than 50mg/l as calcium carbonate
or waters containing high carbon dioxide concentrations (>25mg/l), and galvanized
steel is unsuitable for these waters. Electrolytic corrosion can occur where galvanized
steel or iron pipes or fittings are connected with copper tube or brass fittings.
503
ANNEX 6
Guidance Radio
level (Bq/l)a nuclide
10 000
71
Be
10 000
73
100
74
Na
100
76
100
77
1 000
75
100
82
Cl
100
86
Ca
100
85
Ca
100
89
Sc
100
90
Sc
100
90
Sc
100
91
100
93
10 000
95
3
7
14
22
32
33
35
36
45
47
46
47
48
48
Cr
51
Ge
10 000
105
As
1 000
103
As
100
105
As
100
110m
As
1 000
111
Se
100
109
Br
100
115
Rb
100
115m
Sr
100
111
Sr
100
114m
Sr
10
113
100
125
100
122
Zr
100
124
Zr
100
125
Mn
100
Mn
10 000
94
Mn
100
95
Fe
1 000
93
Fe
100
99
Co
100
96
Co
1 000
97
Co
100
97m
Co
100
99
Ni
1 000
97
Ni
1 000
103
Zn
100
106
52
53
54
55
59
56
57
58
60
59
63
65
Guidance Radio
level (Bq/l)a nuclide
Nb
93m
1 000
Rh
1 000
129
Pd
1 000
131
Ag
100
132
Ag
Cs
1 000
Cs
100
100
100
135
Cd
100
136
Cd
100
137
Cd
Cs
10
Cs
100
Cs
100
Cs
10
Ba
1 000
Ba
100
100
131
1 000
140
In
100
140
Sn
100
139
Sn
100
141
Sb
100
143
Sb
100
144
Sb
100
143
100
147
1 000
147
100
149
1 000
151
100
153
1 000
152
100
154
100
155
10
153
10
160
169
10
171
Te
123m
Nb
100
Te
Nb
100
127m
Mo
100
129
Mo
100
129m
Tc
100
131
Tc
1 000
Te
Te
Te
Te
Te
131m
100
132
Te
Tc
100
125
Ru
1 000
126
Ru
100
129
Ru
10
131
504
1 000
Ag
In
Guidance
level (Bq/l)a
Cs
134
127
Tc
Guidance Radio
level (Bq/l)a nuclide
La
100
Ce
1 000
Ce
100
Ce
100
Ce
10
Pr
100
Nd
100
Pm
1 000
Pm
100
Sm
1 000
Sm
100
Eu
100
Eu
100
Eu
1 000
Gd
1 000
Tb
100
Er
1 000
Tm
1 000
Guidance Radio
level (Bq/l)a nuclide
Yb
1 000
210
Ta
100
206
1 000
207
1 000
210
Re
100
210
Os
100
223
Os
100
224
Os
100
225
Ir
100
226
Ir
100
228
1 000
227
175
182
181
185
186
185
191
193
190
192
Pt
191
Pbb
245
246
100
247
b,c
10
248
Np
249
Np
100
246
Pu
248
Pu
1 000
249
Pu
250
Pu
251
Pu
252
Pu
10
253
Pu
254
Pu
253
Am
254
Am
1 000
235
Ra
236
Rab
237
Ra
238
Rab
237
Rab
0.1
239
Thb
10
236
Th
237
0.1
238
239
Thb
1 000
240
241
Thb
100
242
Pa
100
244
1 000
231
Hg
Th
Th
100
232
Tl
1 000
234
Tl
1 000
230
Tl
1 000
231
Tl
100
233
1 000
230
Pb
Ub
0.1
1 000
203
244
100
Hg
204
Pob
Au
202
243
Bi
230
201
234
229
200
233
100
203
242
100
1 000
197
243
100
Pt
199
1 000
Bi
b
Th
Pab
Pa
U
0.1
100
1
Guidance Radio
level (Bq/l)a nuclide
231
Bi
Au
198
0.1
232
228
193m
Guidance Radio
level (Bq/l)a nuclide
241
242
Am
242m
Guidance
level (Bq/l)a
Am
Cm
10
Cm
Cm
Cm
Cm
Cm
Cm
0.1
Bk
100
Cf
100
Cf
10
Cf
Cf
Cf
Cf
Cf
100
Cf
Es
10
Es
10
Es
254m
100
uidance levels are rounded according to averaging the log scale values (to 10n if the calculated value was below
G
3 10n and above 3 10n1).
b
Natural radionuclides.
c
The provisional guideline value for uranium in drinking-water is 30 g/l based on its chemical toxicity for the kidney
(see section 8.5).
a
505
506
ISO (2007) Standard ISO 10703: Water qualityDetermination of the activity concentration of
radionuclidesMethod by high resolution gamma-ray spectrometry. Geneva, International
Organization for Standardization.
ISO (2008) Standard ISO 9697: Water qualityMeasurement of gross beta activity in non-saline
waterThick source method. Geneva, International Organization for Standardization.
ISO (2009) Standard ISO 5667-11: Water qualitySamplingPart 11: Guidance on sampling of
groundwaters. Geneva, International Organization for Standardization.
ISO (2009) Standard ISO 10704: Water qualityMeasurement of gross alpha and gross beta activity in non-saline waterThin source deposit method. Geneva, International Organization
for Standardization.
ISO (2010) ISO 969: Water qualityDetermination of tritium activity concentrationLiquid
scintillation counting method. Geneva, International Organization for Standardization.
ISO (2010) Standard ISO 11704: Water qualityMeasurement of gross alpha and beta activity
concentration in non-saline waterLiquid scintillation counting method. Geneva, International Organization for Standardization.
ISO (in preparation) Standard ISO 13160: Water qualityMeasurement of strontium 90 and
strontium 89. Geneva, International Organization for Standardization.
ISO (in preparation) Standard ISO 13161: Water qualityMeasurement of polonium 210 activity concentration in water by alpha spectrometry. Geneva, International Organization for
Standardization.
ISO (in preparation) Standard ISO 13162: Water qualityDetermination of carbon 14 activity
Liquid scintillation counting method. Geneva, International Organization for Standardization.
ISO (in preparation) Standard ISO 13163-1: Water qualityMeasurement of lead 210 activity
concentrationPart 1: Liquid scintillation counting method. Geneva, International Organization for Standardization.
ISO (in preparation) Standard ISO 13164-1: Water qualityMeasurement of the activity concentration of radon-222 and its short-lived decay productsPart 1: Radon origins and measurement
methods. Geneva, International Organization for Standardization.
ISO (in preparation) Standard ISO 13164-2: Water qualityMeasurement of the activity concentration of radon-222 and its short-lived decay productsPart 2: Direct measurement by
gamma spectrometry. Geneva, International Organization for Standardization.
ISO (in preparation) Standard ISO 13164-3: Water qualityMeasurement of the activity concentration of radon-222 and its short-lived decay productsPart 3: Indirect measurement with
degassing. Geneva, International Organization for Standardization.
ISO (in preparation) Standard ISO 13165-1: Water qualityMeasurement of radium 226 activity
concentrationPart 1: Liquid scintillation counting method. Geneva, International Organization for Standardization.
Lariviere D et al. (2009) Rapid and automated analytical technologies for radiological nuclear
emergency preparedness. In: Koskinen AN, ed. Nuclear chemistry: New research. Nova Science Publishers, Inc., pp. 99154.
NSF International (2005) Contaminant guide. Ann Arbor, MI, NSF International (http://www.
nsf.org/consumer/drinking_water/dw_contaminant_guide.asp?program=WaterTre).
NSF International (2005) Contaminant testing protocols. Ann Arbor, MI, NSF International
(http://www.nsf.org/consumer/drinking_water/dw_contaminant_protocols.asp).
Prichard HM, Gesell TF (1977) Rapid measurements of 222Rn concentrations in water with a
commercial liquid scintillations counter. Health Physics, 33:577581.
Prichard HM, Venso EA, Dodson CL (1991) Liquid scintillation analysis of 222Rn in water by
alpha/beta discrimination. Radioactivity and Radiochemistry, 3:2826.
507
508
ANNEX 7
his annex lists the names of those who have contributed to the development of
the fourth edition of the Guidelines for drinking-water quality, through participation at relevant meetings, through authorship or peer review of text in the Guidelines
themselves or its supporting documents or through provision of intellectual advice.
The list of contributors begins with the first meeting at which the fourth edition was
discussed, held in Berlin, Germany, in 2007. All those who contributed to the third
edition of the Guidelines as well as the first and second addenda to the third edition,
which constitute a major portion of this fourth edition, are listed in Annex 2 of the
third edition incorporating the first and second addenda, available on the WHO web
site at http://www.who.int/entity/water_sanitation_health/dwq/GDWAN2rev1and2.
pdf. Sincere apologies are extended to any contributors whose names have inadvertently been omitted from these lists.
C. Abbot, United Utilities, Warrington, England
H. Abouzaid, World Health Organization, Cairo, Egypt
L. Achene, Istituto Superiore di Sanit, Rome, Italy
J. Adams, Liverpool School of Tropical Medicine, Liverpool, England
A. Adin, Hebrew University of Jerusalem, Jerusalem, Israel
S. Adrian, Environmental Protection Agency, Washington, DC, USA
R. Aertgeerts, World Health Organization European Centre for Environment and
Health, Rome, Italy
F. Ahmed, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
A. Aitio, World Health Organization, Geneva, Switzerland
H. Al-Hasni, Public Authority for Electricity and Water, Muscat, Oman
N. Al-Hmoud, Princess Sumaya University for Technology, Amman, Jordan
G. Allgood, The Procter & Gamble Company, Cincinnati, USA
B.M. Altura, New York Downstate Medical Center, New York, USA
B.T. Altura, New York Downstate Medical Center, New York, USA
509
510
515
517
Index
INDEX
INDEX
INDEX
defined 52
determining 6162
monitoring performance see
Operational monitoring
non-piped, community and household
systems 5859
operational and critical limits 63
piped distribution systems 5758
resource and source protection 5455
treatment stage 5556
validation see Validation
Cooling towers 244, 245
Copper 184, 340342
acceptability 224225, 341
analysis 479
corrosion 501
guideline value 188, 341, 473
health effects of acute exposure 196
impingement attack 501
pitting 501
Corrosion 174175
control strategies 175
desalinated water 98
galvanic 502
inhibitors 502
pH and 174175, 226227
pitting 501
potential, characterizing 175
treatment and distribution systems
493503
Cosmic radiation 204, 206
Costs
water supply 8586
water treatment 171
Coxsackieviruses 263
Crangonyx pseudogracilis 221
Critical limits 63
Crustaceans 221
Cryptosporidiosis 273
Cryptosporidium 119, 273274
in faeces, wastewater and raw water 136
performance targets 133134
as reference pathogen 127128
risk assessment 132
treatment efficacy 145146, 174
Cryptosporidium hominis 273
Cryptosporidium parvum 273
Ct concept 56
Culex larvae 222
Cyanazine 342
523
analysis 481
guideline value 183, 342, 473
treatment performance 497
Cyanide 179, 342344, 346347, 469
Cyanobacteria 176, 293294
acceptability 221
blooms 221, 294, 345
toxins see Cyanotoxins
treatment performance 500
Cyanogen chloride 186, 343344, 346347,
469
Cyanotoxins 176, 293294, 344346
analysis 484
treatment 346, 500
see also Microcystin-LR
Cyanuric acid 417
Cyclops 221, 222, 286
Cyclospora cayetanensis 119, 274276
Cyclosporiasis 275
Cylindrospermum spp. 293
Cypermethrin 181, 468
INDEX
Echinococcus 120
Echoviruses 263
Edetic acid (EDTA) 364365
analysis 480
guideline value 180, 365, 474
treatment performance 495
EDTA see Edetic acid
Education programmes 12, 14, 63
building owners and managers 106
establishing 87
Electron capture detection (ECD) 478
Electrothermal atomic absorption
spectrometry (EAAS) 477
ELISA (enzyme-linked immunosorbent
assay) 478
Emergencies 72, 100102
chemical contamination 192201
consumer acceptability 199
determining appropriate action
198199
evaluating health significance 195
198
health-based values 197198
informing public 195
investigation 194
liaison with key authorities 194195
mixtures 199200
sensitive subpopulations 198
trigger for action 194
updating water safety plan 199
water avoidance advisories 200201
documentation and reporting 25, 71
follow-up investigation 71
longer-term planning 101
microbial quality problems 150153
response plans 6970, 72
verification testing 67
water safety plan review after 76
see also Incidents
Emerging diseases 122123, 269
Encephalitis, granulomatous amoebic 269,
270
526
INDEX
-Galactosidase 295
Galvanized iron 503
Gammarus pulex 221
Gas chromatography (GC) 478
Gas chromatography/mass spectrometry
(GC-MS) 478
Gastroenteritis
adenovirus 259
astrovirus 260
calicivirus 262
rotavirus 267
Salmonella 250, 251
Yersinia 257
see also Diarrhoea
Geosmin 221
527
INDEX
verification testing 67
water safety plan review after 76
see also Emergencies
Incremental improvement concept 3, 36, 37
Indicator organisms 294306
criteria 147148
detection methods 150
grading water quality 90, 91
presence/absence testing 66
in source waters 136, 137138
use in monitoring 24, 147149
validation 60
verification 26, 65, 66, 67
see also specific organisms
Individual dose criterion (IDC) 206, 207
contribution of each radionuclide to
210
remedial measures 214
screening levels and 207208
screening of supplies and 209
Inductively coupled plasma atomic emission
spectrometry (ICP-AES) 477
Inductively coupled plasma mass
spectrometry (ICP-MS) 477
Industrial sources and human dwellings,
chemicals from 158, 177179
analysis 479, 480
guideline values 179, 180
treatment performance 495496
Infants
bottle-fed 196, 398, 399, 400, 402403
radionuclide guidance levels 212213
see also Children
Infectious diseases 117, 118123
asymptomatic 124, 130
emerging issues 122123
health outcome targets 135136
public health aspects 11, 124
routes of transmission 5, 120, 123
vulnerable subpopulations 12, 120,
124
see also Microbial hazards; Pathogens
Infectious dose 130
Influenza viruses 121, 122
Information channels, establishing 87
Inhalation
adapting guideline values 31, 168
microbial pathogens 120, 123
radionuclides 206
radon 204, 215
INDEX
Laboratories
analysis of chemicals 169
in emergencies and disasters 102
Lactose fermentation 295, 296
Land use 1213, 53
Langelier index 175
Larson ratio 175
Larvicides, aquatic 190191, 193, 434442
Latrines 178
Lead 184, 383384
analysis 479
corrosion 502
guideline value 188, 383, 474
priority 29
sampling locations 67
Lead-210 211
Legionella spp. 57, 119, 244245
growth in water 123
health-care facilities 107
large building systems 105
route of transmission 120
Legionellosis 244
Legionnaires disease 244
Leptospira 119, 245247
Leptospirosis 246, 247
Lindane 385386
analysis 481
guideline value 183, 385, 474
treatment performance 498
Liver flukes see Fasciola
LOAEL see Lowest-observed-adverse-effect
level
Local authorities 1112
Low-income countries, performance targets
133, 134
Lowest-observed-adverse-effect level (LOAEL)
160, 161
uncertainty factors 162
Lyngbya spp. 293
Magnesium 225, 377
Malathion 182, 386, 470
Management
community and household supplies
7475
piped distribution systems 6974
plans 24, 46, 6975
531
analysis 482
guideline value 183, 393
treatment performance 498
Microbial aspects 45, 117153
Microbial fact sheets 231306
Microbial growth 123
desalinated water 99
piped distribution systems 105, 120
Microbial hazards 117124
health-based targets 41, 43, 124136
health outcome targets 135136
identification 128
risk assessment see Quantitative
microbial risk assessment
risk-based performance target setting
131135
turbidity as indicator 228229
Microbial monitoring 147149
Microbial pathogens see Pathogens
Microbial quality
assessing priorities 29
community supplies 75
grading schemes based on 9091
responses to problems and emergencies
150153
verification 26, 6566, 149
Microcystin-LR 176, 344346
analysis 484
guideline value 178, 344, 474
Microcystins 176, 344
Microcystis spp. 293, 344
Microfiltration 492
Microsporidia 121, 280282
Millennium Development Goals 33, 85
Mineral waters, natural 115
Mirex 181, 468
Molinate 184, 393394, 474, 482
Molluscs 222
Molybdenum 177, 394, 471
Monitoring
dissolved radionuclides 208212
in emergencies and disasters 101102
microbial 147149
operational see Operational monitoring
plans, preparing 73
temporary water supplies 104
see also Sanitary inspection; Surveillance
Monobromoacetate 186, 326, 471
Monochloramine 331332
acceptability 223
analysis 482
by-products 172, 174
disinfectant activity 486
guideline value 187, 331, 474
Monochloroacetic acid (monochloroacetate)
395
analysis 483
guideline value 188, 395, 474
Monochlorobenzene (MCB) 179, 223224,
395396, 471
Monocrotophos 181, 468
Moraxella 298
Mosquitoes
breeding in containers 95, 190
pesticides for control 190191, 193,
434442
Multiagency approach, collaborative 8
Multiple-barrier principle 4, 52, 143144
MX (3-chloro-4-dichloromethyl-5-hydroxy2-(5H)-furanone) 186, 396, 471
Mycobacterium (mycobacteria) 247249
atypical (non-tuberculous) 119, 120
122, 247248
in free-living nematodes 289
health-care facilities 107
Mycobacterium avium complex 247, 248
Mycobacterium kansasii 248
Naegleria fowleri 119, 120, 282283
control measures 57
growth in water 123
Nais worms 222
Nanofiltration 492
National priorities, supply improvement 87
National standards and regulations 3033
chemical contaminants 156157
developing 23, 3031
periodic review and revision 31
supporting policies and programmes 33
Natural disasters 57
Natural mineral waters 115
Naturally occurring chemicals 158, 176177
analysis 479
guideline values 177, 178
with no guideline values 177
treatment performance 494
Naturally occurring radionuclides 203204,
205
Necator (americanus) 120, 289, 290
Nematodes
532
INDEX
Norms, drinking-water 10
Noroviruses 119, 261262
as reference pathogens 127
Nosema 280
Nosocomial infections see Hospital-acquired
infections
Nostoc spp. 293
Novaluron 191, 193, 437, 471
Odour 78, 220221
biologically derived contaminants 221
222
chemical contaminants 222230
treatments for removing 230
Operational limits 63
Operational monitoring 2324, 46, 60,
6164
parameters 6263, 64
plans, preparing 73
use of indicator organisms 148
Organolead compounds 383
Organotins 350
Orthoreoviruses 267268, 305, 306
Oscillatoria spp. 293
Osmosis 492
see also Reverse osmosis
Oxamyl 181, 468
Oxidation processes, advanced 492493
Oxidationreduction potential 62
Oxygen, dissolved 225
Ozonation 486
advanced oxidation processes 492493
alternatives to 174
by-products 172, 185
household use 142
microbial reduction 140
Ozone 486
chemical contaminants 189
Packaged drinking-water 114115
in emergencies and disasters 101
see also Bottled water
Parasites 268292
secondary hosts 222
see also Helminths; Protozoa
Parathion 182, 406407, 471
Parechoviruses 127
Particulate matter 221, 228
Pathogens 118122, 231232
bacterial 119, 121, 232258
533
INDEX
136
viruses 126127
Regional level
establishing priorities 87
use of data for priority setting 9092
Regulations 3233
see also National standards and
regulations
Reporting
incidents and emergencies 25, 71
radioactivity analysis 217
surveillance information 8992
Reservoirs 54, 139
Resource protection 5355
control measures 5455
hazard identification 5354
Respiratory viruses 258, 259
Reverse osmosis 492
household use 176
use by travellers 109, 111
Rhabditis 289
Risk
characterization, infectious diseases
130131, 132
communication, radiation 217218
defined 50
reference level 3738
scoring and ranking 5152, 53
Risk assessment
chemical emergencies 195198
holistic approach 34
quantitative microbial see Quantitative
microbial risk assessment
Stockholm Framework 3
Riskbenefit approach 2
Roles and responsibilities, management
817
Roof materials, rainwater harvesting 95
Rotaviruses 119, 267268, 305
in faeces, wastewater and raw water 136
performance target setting 133, 134135
as reference pathogens 126
risk assessment 131, 132
Roughing filters 488
INDEX
Silver 415
disinfection 108, 487
lack of guideline value 186, 415, 471
Simazine 415416
analysis 482
guideline value 184, 416, 474
treatment performance 498
Single-hit principle 130
Snails 120, 222, 291
SODIS system 143
Sodium 177, 416, 471
taste threshold 227
Sodium bromate 324
Sodium cyanurate 418
Sodium dichloroisocyanurate 110, 141,
417418
analysis 482
by-products 185
guideline value 187, 417, 474
Sodium hypochlorite 110, 141, 485
bromate residue 189
decomposition products 188
Sodium sulfate 227
Sodium trichloroisocyanurate 141
Softening 377
household use 176
methods 491, 493
microbial reduction 139
see also Hardness
Solar disinfection 143, 146
Solids, total dissolved see Total dissolved
solids
Source protection 5355, 101
Source waters
community and household systems 63,
75
hazard identification 5354
microbial hazards 120
naturally occurring chemicals 176177
new systems 50
operational monitoring 62, 63
pathogen occurrence 136137
performance targets 43
radioactive contamination 214
radon 214215
verification testing 66, 67
see also Catchments
Spas 244, 248, 282
Specified technology targets 21, 40, 4344
application 40, 41
537
INDEX
Toxocara 120
Toxoplasma gondii 121, 283285
Toxoplasmosis 283284
2,4,5-TP see Fenoprop
Trachipleistophora 280
Transport, vended water 96
Travellers 107109, 110111
Treatment 5556
central 138140
chemicals used in see Chemicals used in
water treatment/materials
in contact with water
control measures 5556
for corrosion control 175
corrosion of metals used in 493503
desalinated water 98, 99
hazard identification 55
household see Household treatment and
storage
membrane processes 492
methods 485493
microbial reductions 139140
ranking of complexity/costs 171
see also specific treatments
microbial reduction 138147
operational monitoring 62, 64
performance 493, 494500
performance targets 43, 132135
pharmaceuticals 190
plants, design of new 5051
radioactive contamination 214, 215
removal of chemicals 170176
household use 175176
process performance 171172
stored rainwater 9596
taste, odour and appearance problems
230
for travellers 108109, 110111
turbidity 228, 229
validation 60
water quality targets 4243
see also Disinfection
Triazophos 181, 468
Tributyltin oxide (TBTO) 181, 468
Tricaprylin 376
Trichloramine 331332, 486
lack of guideline value 186, 332, 472
taste and odour 223
Trichlorfon 181, 468
Trichloroacetaldehyde see Chloral hydrate
539
Ultrafiltration 492
Ultraviolet (UV) absorption 476
Ultraviolet (UV) irradiation 140, 174,
486487
household methods 143, 146
Umezakia natans 293
Uncertainty factors (UF) 160, 162163
data-derived see Chemical-specific
adjustment factors
540
INDEX
Wastewater
chemicals in 178
pathogens and indicator organisms 136,
137138
temporary water supplies and 103
Water avoidance advisories 72, 200201
Water quality see Quality, drinking-water
Water quality targets (WQTs) 21, 40, 4243
application 40, 41
see also Guideline values
Water resource management 1213
see also Resource protection
Water safety plans (WSPs) 20, 2225, 4576
aircraft and airports 109, 112
approval and review 7879
audit 69, 78, 87
benefits of using 47
buildings 104, 105
communication 25, 46, 76
documentation 2425, 7576
health-care facilities 107
key components 46
management plans 24, 46, 6975
model 59
operational monitoring 2324, 46, 6164
planned review 76
post-incident actions 199
ships 113114
in specific circumstances 9394
steps in developing 48
supporting programmes 7374
surveillance see Surveillance
system assessment and design 2223,
46, 4961
Xanthomonas 298
Xylenes 432433
analysis 480
guideline value 180, 433, 475
odour threshold 229
treatment performance 496
Yersinia 257258
Yersinia enterocolitica 121, 257
Yersinia pseudotuberculosis 257
Yersiniosis 257
Zebra mussel 222
Zinc 187, 433434, 472
acceptable level 229230
corrosion 503
dissolution from brass 493
Zoning, urban areas 81
Zoonotic pathogens 122
541